Lorazepam IV 4 mg or 0.1 mg/kg may repeat one dose.May also be given IN at 0.2 mg/kg, max 10 mg.Benzodiazepine (Initial treatment of choice).Jaw thrust, a NPA and oxygen may be required.If possible, place patient in left lateral position to reduce risk of aspiration.Consider emergent CT head, plus/minus LP.Post-hypoxic myoclonus ( Status myoclonicus).Psychogenic nonepileptic seizure (pseudoseizure).Toxic ingestion (amphetamines, anticholinergics, cocaine, INH, organophosphates, TCA, salicylates, lithium, phenothiazines, bupropion, camphor, clozapine, cyclosporine, fluoroquinolones, imipenem, lead, lidocaine, metronidazole, synthetic cannabinoids, theophylline, Starfruit).Posterior reversible encephalopathy syndrome.Metabolic abnormalities: hyponatremia, hypernatremia, hypocalcemia, hypomagnesemia, hypoglycemia, hyperglycemia, hepatic failure, uremia.Non-compliance with anti-epileptic medications.
NCSE presents as an alteration in behavior associated with subtle changes (as twitching, blinking, eye deviation, aphasia, somatosensory findings) and continuous epileptiform discharges on EEG.Divided in generalized convulsive status epilepticus (GCSE) and nonconvulsive status epilepticus (NCSE).(Previous definitions used a 30-minute time limit) Definitions have varied, but status epilepticus should be considered in a patient seizing for 5-10min despite initial treatments or recurrent seizure activity without return to baseline mental status.
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