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Home | Articles | Emergencies | Management of Prolonged Seizures (Convulsive Status Epilepticus) in Children

Management of Prolonged Seizures (Convulsive Status Epilepticus) in Children

Last updated 20th June 2024

Introduction

This guideline has been updated to reflect the 2023 APLS guideline on Management of the Convulsing Child.

Convulsive Status Epilepticus

A seizure is considered prolonged if it lasts more than 5 minutes.

After 5 minutes, a seizure is unlikely to self-terminate.

Seizures lasting longer than 30 minutes are associated with increased risk of death and long-term neurological consequences.

Status-epilepticus-7e-2023Download

Primary Assessment and Resuscitation

ABCDE assessment as for any unwell child, including:

Airway – maintain airway, manage secretions

Breathing – administer high flow oxygen, attach monitoring

Circulation – establish IV/IO access

Disability – assess conscious level, check pupils, check glucose

  • Obtain brief history of events, past medical history, drug history and allergies.
  • Focused physical examination may help to identify underlying cause
  • Take bloods for FBC, U&E, CRP, Ca, Mg, LFTs, Glucose, Blood cultures (if febrile), anti-epileptic drug levels (if on treatment).

Remember children with epilepsy may have an individual emergency plan which (if available) should be used for this patient rather than the standard algorithm.

Drug doses

All are in line with doses recommended in BNFc.

  • Steps 1 & 2 – Benzodiazepines
    • *Pre-hospital doses of benzodiazepines should be included – maximum 2 doses of benzodiazepines before proceeding to next step*

Step 3 & 4

References

Bacon M, Appleton R, Bangalore H, Brand C, Browning J, Chin RF, Mahal S, Saranga Estevan S, McHale K, McLellan A, Milne N, Pujar S, Rao T, Short S, Warriner S, Yoong M. Review of the new APLS guideline (2022): Management of the convulsing child. Arch Dis Child Educ Pract Ed. 2022 Jun 22:edpract-2021-323351. doi: 10.1136/archdischild-2021-323351. Epub ahead of print. PMID: 35732467.

NHSGGC Paediatric Guidelines. Status Epilepticus Management. Reviewed April 2022. https://www.clinicalguidelines.scot.nhs.uk/nhsggc-guidelines/nhsggc-guidelines/emergency-medicine/status-epilepticus-management/