Patient handout

Convulsive Status Epilepticus

PRODUCTION

1. Your condition

This handout is for convulsive status epilepticus. Your care team identified this based on: continuous seizure ≥5 min (ilae 2015 t1 definition, trinka et al).

Other reasons your team may use this plan: recurrent seizures without recovery to baseline (ilae 2015 operational definition); ams with seizure history — suspect ncse (ncs 2012 ceeg indication); ceeg showing electrographic seizure activity (ncs 2012 monitoring criteria).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
lorazepam	0.1 mg/kg IV (typical 4 mg per dose; max 4 mg per dose); can repeat once at 5 min (AES 2016 Glauser et al)	IV	q5 min × 2 max	AES 2016 + Treiman NEJM 1998 — first-line IV benzo; repeat once at 5 min
midazolam	10 mg IM (or 5 mg if <40 kg); IN 0.2 mg/kg; buccal 0.5 mg/kg	IM/IN/buccal	single	RAMPART (NEJM 2012) — IM midazolam non-inferior to IV lorazepam
diazepam	0.15–0.2 mg/kg IV (typical 5–10 mg); rectal 0.2–0.5 mg/kg if no IV	IV/PR	q5 min × 2 max	AES 2016 alternative when lorazepam unavailable; Treiman NEJM 1998 comparator

Plan: Status epilepticus — NCS/AES 4-stage ladder

3. When to call your provider

Contact your care team if any of the following happen:

Breakthrough seizure → re-evaluate adherence + trigger + AED level; consider 2nd AED add-on (AAN 2015)
Drug-resistant epilepsy (≥2 AED failed) → epileptology referral for surgical / VNS / RNS / DBS / dietary therapy (ILAE 2010 drug-resistant definition)
SE recurrence → ED (NCS 2012)
PHQ-9 ≥15 OR suicidal ideation → urgent psych referral (epilepsy + AED suicide-signal — FDA black-box on LEV / topiramate / VPA)
Pregnancy declared → switch off VPA / topiramate; transition to LEV or lamotrigine BEFORE conception if possible; folic acid 4–5 mg PO daily

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Stage 1 (5–20 min — early/abortive) — continuous seizure ≥5 min OR recurrent without recovery (ILAE 2015 t1 operational definition)
Stage 2 (20–40 min — established) — seizure not terminated after 2 benzo doses (AES 2016 escalation criteria)
Stage 3 (40+ min — refractory) — failed Stage 1 + Stage 2 (Rossetti Lancet Neurol 2011 refractory definition)(life-threatening)
Stage 4 (>24 h on cIV — super-refractory) — continued or recurrent SE >24 h on first cIV agent (Shorvon/Rossetti Lancet Neurol 2011)(life-threatening)
Pregnancy ≥20 weeks or ≤6 weeks postpartum with seizure (ACOG 2020 eclampsia criteria)(life-threatening)
Seizure with INH (isoniazid) overdose history; toxic-metabolic etiology (AES 2016 toxin-provoked SE)
Posterior reversible encephalopathy syndrome (PRES) — typical occipital/parietal vasogenic edema on MRI; hypertensive emergency, eclampsia, immunosuppressants (cyclosporine, tacrolimus), uremia
New-onset refractory SE (NORSE) or febrile-infection-related epilepsy syndrome (FIRES — pediatric NORSE variant; preceded by febrile illness 2 wk prior)(life-threatening)
Propofol Infusion Syndrome (PRIS) — any 2 of: lactic acidosis (lactate ≥2.5), CK ↑ (>5000), triglycerides ↑ (>500), bradycardia, hypotension on increasing pressors, RBBB/Brugada-pattern ECG; risk = propofol >80 µg/kg/min for >48 h (NCS 2012 PRIS criteria)(life-threatening)

5. Follow-up

Long-term AED plan, driving counsel, epilepsy clinic referral per AAN/AES post-SE recommendations

6. Sources

Guideline: NCS 2012/2016 SE Guideline (Brophy 2012) + AES 2016 Convulsive SE Guideline (Glauser 2016) + ILAE 2015 Classification (Trinka) + ILAE 2020 Pediatric SE + NICE NG217 (2024) + ESETT (Kapur NEJM 2019) + RAMPART (Silbergleit NEJM 2012) + ACOG 2020 Eclampsia. Guideline-floor WebSearch-revalidated 2026-05-18: Vignatelli Epilepsia 2024 systematic review of SE CPGs confirms NO paradigm change — midazolam/lorazepam first-line, LEV/fosphenytoin/valproate second-line all remain canonical.