20.01.4 Treatment of Status Epilepticus

The first line treatment of status epilepticus is the benzodiazepines. The benzodiazepines are used i.v. or rectally. The benzodiazepines are active after oral administration, but oral administration is usually not possible and too slow in status epilepticus. The benzodiazepines most commonly used in the treatment of status epilepticus are lorazepam and diazepam.

Lorazepam has short onset of action, and a long t_1/2 (14 h). Thus, lorazepam rapidly suppresses neuronal activity, and the suppression of neuronal activity with lorazepam lasts for long period. The alternative is diazepam, which is slower to act and the suppression does not last so long. Thus, when diazepam is used in status epilepticus, the status epilepticus may break through, and this requires another dose of diazepam to be given.

The second line treatment for status epilepticus is phenytoin.