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What is the Treatment Choice for Status Epilepticus?

Patients who suffer from prolonged seizures or status epilepticus, getting the earliest possible treatment is quite important. This is because the prolonged duration of seizures may cause severe brain damage and may even lead to death. It is important to be checked by a doctor after the very first episode of seizure so that the doctor can prescribe emergency medicines whenever needed.

What is the Treatment Choice for Status Epilepticus?

There are certain guidelines which have to be followed for treating status epilepticus. A time-dependent treatment guideline is to be followed for proper management-

  • Initially for status epilepticus, first aid for the seizures should be given. It is important to note the time at every step.
  • A benzodiazepine is usually suggested in the initial therapy.
  • When the seizures do not seem to arrest, valproic acid IV fosphenytoin or levetiracetam may be used. An alternative to the above includes IV Phenobarbital.
  • If the patient experiences a seizure activity for more than 40 minutes, the third phase of treatment has to be started. These consist of using the second line therapy by using anaesthetics to medically induce the patient to coma. Drugs that may be used include thiopental, propofol or pentobarbital.

What are the Various Modes of Administration of the Treatment for Status Epilepticus?

Status epilepticus is a condition where a patient might need immediate medication. Thus the mode of drugs to be given as a treatment procedure for status epilepticus is also varied.

  • Drugs for status epilepticus can be given in oral formulations. They are available for clonazepam, diazepam, and lorazepam. It should be noted that this mode of administration takes relatively longer time to start its action. These medications for status epilepticus might be prescribed by the doctor and are readily available in most of the pharmacies with prescriptions.
  • Another mode of giving drugs to the patient with status epilepticus is intranasal which include within the nose therapies. Drugs given through intranasal therapies include as midazolam or diazepam due to their property of rapid absorption and relatively easy administration. It is mandatory for the caregiver to receive some training for its administration.
  • At times, rapid administration of the medicine is required. This mode of status epilepticus treatment is Intramuscular (within the muscle) medications. Such forms of treatment can be rapidly administered. The disadvantage of such administration is that the absorption can be unreliable. Also, there might be a risk of complications at the injection site.
  • Mode of administration of the status epilepticus treatment can also be Intrapulmonary which is the within the lungs administration. This makes the medication to be taken up directly into the pulmonary capillaries, which then flows to the heart and ultimately reached the brain with direct blood flow. This route is very fast and effective for immediate treatment. Yet more researches are needed for this form of administration as to which form of drugs would be best suited for such administration.
  • The most common form of status epilepticus treatment administration is the rectal form. Diazepam is the common form of drug used for such administration. Presently it is the only form of administration which is FDA approved for at-home treatment of status epilepticus. Although this is widely available, this mode of administration is quite problematic in many cases.

How to Reduce the Risk of Death from Status Epilepticus?

As it is clear that status epilepticus can be a form of medical emergency, it is important to understand the importance of proper medicine to reduce the risk of death due to status epilepticus. The patient should ask for a written care plan from the doctor or the nurse for emergency circumstances. Caregivers should also be informed how to handle the patient at the time of emergencies.


  1. “Status Epilepticus: Management and Prognosis” – StatPearls Article: https://www.ncbi.nlm.nih.gov/books/NBK499938/

  2. “Status Epilepticus: An Overview” – Cleveland Clinic Article: https://my.clevelandclinic.org/health/diseases/9832-status-epilepticus

  3. “Seizures and Epilepsy: Hope Through Research” – National Institute of Neurological Disorders and Stroke (NINDS) Article: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Epilepsies-and-Seizures-Hope-Through

  4. “Status Epilepticus” – Epilepsy Foundation Website: https://www.epilepsy.com/learn/about-epilepsy-basics/what-happens-during-seizure/status-epilepticus

  5. “Management of Convulsive Status Epilepticus in Adults” – BMJ Best Practice Article: https://bestpractice.bmj.com/topics/en-gb/834

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Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:August 11, 2023

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