Managing status epilepticus

New drug offers real advantages

Status epilepticus is a medical emergency familiar to accident and emergency departments, acute medical wards, and intensive care units. It is defined as a continuous seizure lasting for at least 30 minutes,1 or two or more discrete seizures between which the patient does not recover consciousness, and in the 15-30 patients per 100 000 per year who present in status epilepticus mortality may be as high as 10%. The longer seizures persist the more difficult they are to control and the higher the mortality,2 with an increase in neuronal damage and chronic epilepsy. Until recently phenytoin has been the drug of choice for managing prolonged seizures, but it has to be given intravenously and major side effects are common. Fosphenytoin is a prodrug of phenytoin, recently licensed in the United Kingdom, that seems to offer several advantages over its parent.

Status epilepticus is challenging to treat and may be difficult to diagnose. In early status epilepticus patients usually have visible tonic-clonic seizures, although motor-convulsive activity can decline. Diagnosis may require electroencephalographic monitoring, because some …