When SE does not respond to treatment as expected, the clinician's attention should refocus along several lines:

  • Is the diagnosis of SE correct?
  • Has the underlying cause been correctly assessed? This is crucial, because SE is most likely to continue when trauma, hemorrhage, or infections such as encephalitis remain untreated.
  • Have medications been given in adequate doses? (The 1000-mg standard phenytoin infusion may be insufficient, for example.)
  • Have medications been adequately absorbed? Absorption can be a problem if there are difficulties with intravenous access or if the drug is given by another route.
  • Has the SE recurred after successful treatment? This situation most often results from inadequate attention to maintenance levels of longer-acting anticonvulsants or lack of treatment of the underlying disease.
Adapted from: Drislane FW. Status epilepticus. In: Schachter SC, Schomer DL, eds. The comprehensive evaluation and treatment of epilepsy. San Diego, CA: Academic Press; 1997. p. 149-172.
With permission from Elsevier (www.elsevier.com)
Authored By: 
Frank W. Drislane MD
MD
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Reviewed By: 
Thaddeus Walczak
MD
on: 
Thursday, January 1, 2004