Management of Generalised Convulsive Status Epilepticus in Adults Guideline - Update
The NHSGGC management of generalised convulsive status epilepticus in adults guideline has been updated and is available here. A link to this guideline is also available in the NHSGGC Adult Therapeutics Handbook here.
Key changes
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Benzodiazepine options, doses and routes of administration for initial treatment have been updated
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Three antiepileptic drugs (AEDs) are now included as treatment options when seizures persist following benzodiazepines:- Levetiracetam, sodium valproate and phenytoin
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Details of indications, cautions and considerations are included to help guide choice of treatment
Background
Convulsive status epilepticus (continuous or recurrent seizures over 5 minutes, or without recovery) is a medical emergency. The guidance is based on the SIGN Guideline on diagnosis and management of epilepsy in adults and up to date trial information. The most significant change from the previous NHSGGC guidance is the inclusion of levetiracetam and sodium valproate as AEDs in addition to phenytoin. Sodium valproate is recommended by SIGN, and levetiracetam use in this setting is supported by a recent large randomised controlled trial.1
Dosing/administration
The guideline includes weight based doses (capped maximum doses) for the three AEDs and advice on administration. Levetiracetam and sodium valproate are used off label for status epilepticus. The recommended infusion rate for sodium valproate is faster than stated in the Adult Intravenous Medicines Monograph but is supported by the literature.
Safety Advice
The guideline includes information on cautions, considerations and significant interactions for the AEDs which should be reviewed prior to prescribing. It is important to note that sodium valproate is contra-indicated in pregnancy and women of child bearing potential.
1. Kapur J, Elm J, Chamberlain JM et al. Randomised trial of three anticonvulsant medications for status epilepticus. NEJM 2019;381:2103-13
Published: 29/04/2022. Medicines Update blogs are correct at the time of publishing
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