Treatment of Convulsive Status Epilepticus in Children and Adults

In adults, IM midazolam, IV lorazepam, IV diazepam (with or without phenytoin), and IV phenobarbital are established as efficacious at stopping seizures lasting at least 5 minutes. (Level A)

Intramuscular midazolam has superior effectiveness compared with IV lorazepam in adults with convulsive status epilepticus without established IV access. (Level A)

Intravenous lorazepam is more effective than IV phenytoin in stopping seizures lasting at least 10 minutes. (Level A)

There is no difference in efficacy between IV lorazepam followed by IV phenytoin, IV diazepam plus phenytoin followed by IV lorazepam, and IV phenobarbital followed by IV phenytoin. (Level A)

Intravenous valproic acid has similar efficacy to IV phenytoin or continuous IV diazepam as second therapy after failure of a benzodiazepine. (Level C)

Insufficient data exist in adults about the efficacy of levetiracetam as either initial or second therapy. (Level U)

In children, IV lorazepam and IV diazepam are established as efficacious at stopping seizures lasting at least 5 minutes. (Level A)

Rectal diazepam, IM midazolam, intranasal midazolam, and buccal midazolam are probably effective at stopping seizures lasting at least 5 minutes. (Level B)

Insufficient data exist in children about the efficacy of intranasal lorazepam, sublingual lorazepam, rectal lorazepam, valproic acid, levetiracetam, phenobarbital, and phenytoin as initial therapy. (Level U)

Intravenous valproic acid has similar efficacy but better tolerability than IV phenobarbital as second therapy after failure of a benzodiazepine. (Level B)

Insufficient data exist in children regarding the efficacy of phenytoin or levetiracetam as second therapy after failure of a benzodiazepine. (Level U)