Evaluation and Treatment of Adult Status Epilepticus in the Emergency Department

Purpose of Review This review summarizes the current knowledge and evidence behind the diagnosis and management of adult status epilepticus (SE) in the Emergency Department (ED). It incorporates the most recent evidence-based diagnostic and management strategies, while reflecting them back onto the foundational aspects of SE care. Recent Findings Recent studies have re-emphasized the importance of early and appropriately dosed benzodiazepines as first-line therapy for SE. Second-line therapy has evolved from phenytoin to alternative anti-epileptics (AEDs) like levetiracetam. Additionally, cerebral perfusion-computed tomography (PCT) and electroencephalogram (EEG) are critical in the diagnosis of non-convulsive SE (NCSE) in the ED. Summary Early and aggressive medical management is crucial to curb the morbidity and mortality of adult SE in the ED starting with benzodiazepines and progressing to AEDs. Patients who remain altered after treatment may still have NCSE. Due to the clinical subtleties associated with NCSE, it is essential to utilize tools such as alternative EEG monitoring and PCT.