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Emerg Med Clin North Am. 2011 Feb;29(1):51-64. doi: 10.1016/j.emc.2010.08.005.

Generalized convulsive status epilepticus in adults and children: treatment guidelines and protocols.

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Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY, USA.


Generalized convulsive status epilepticus (GCSE) has a high morbidity and mortality, such that the rapid delivery of anticonvulsant therapy should be initiated within minutes of seizure onset to prevent permanent neuronal damage. GCSE is not a specific disease but is a manifestation of either a primary central nervous system (CNS) insult or a systemic disorder with secondary CNS effects. It is mandatory to look for an underlying cause. First-line therapies for seizures and status epilepticus include the use of a benzodiazepine, followed by an infusion of a phenytoin with a possible role for intravenous valproate or phenobarbital. If these first-line medications fail to terminate the GCSE, treatment includes the continuous infusion of midazolam, pentobarbital, or propofol.

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