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  6. Generalised convulsive status epilepticus in adults (1003)

Generalised convulsive status epilepticus in adults (1003)

Convulsive status epilepticus (continuing or recurrent seizures over 5 minutes, or without recovery) is a medical emergency with a 16–39% mortality rate. There is a risk that seizures will cause cerebral damage if not controlled within 30 minutes of onset.


This guideline outlines the general management of convulsive status epilepticus in adults (those ≥ 16 years old) and is based on the SIGN guideline for diagnosis and management of epilepsy in adults and up-to-date trial information. Treatment may differ in individual clinical circumstances. Consult specialist guidelines for advice on the management of status epilepticus in pregnant patients.


The management of convulsive status epilepticus is outlined in the treatment pathway below, more detail regarding choice, dosage and administration of antiepileptic drugs can be found by following the relevant links throughout the document.

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Editorial Information

Last reviewed: 06/08/2026

Next review date: 31/12/2028

Author(s): Russell Hewett, Emma Russell, Laura Stobo.

Version: 4

Approved By: Medicines Utilisation Subcommittee of ADTC

Document Id: 1003

References

1.      Scottish Intercollegiate Guidelines Network (SIGN). Diagnosis and management of epilepsy in adults. Edinburgh: SIGN;2015. (SIGN publication no.143). [may 2015, updated September 2018].

2.      National Institute for Health and Care Excellence (NICE). NG217 Epilepsies in children, young people and adults. Published April 2022, updated January 2025

3.      Kapur J, Elm J, Chamberlain JM et al. Randomised trial of three anticonvulsant medications for status epilepticus. NEJM 2019;381:2103-13

4.      Jones S, Pahl C, Trinka E et al. A protocol for the in hospital emergency drug management of convulsive status epilepticus in adults. Pract Neurol 2014;14:194-197

5.      Misra DM, Kalita J, Patel R. Sodium valproate vs phenytoin in status epilepticus: A pilot study. Neurology 2006;67:340-342

6.      Glauser T, Shinnar S, Gloss D, et al. Evidence-based guideline: Treatment of convulsive status epilepticus in children and adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Currents 2016:16(1):48-61

7.      Cock H. Status Epilepticus in Adults (convulsive seizures in patients aged >16 years old). Available from: https://www.stgeorges.nhs.uk/wp-content/uploads/2016/12/Status-epilepticus.pdf

8.      University Hospitals of Liverpool Group. The Walton Centre. Status Epilepticus Guideline. May 2025

9.      NHS Lothian. Guidelines for the in hospital treatment of convulsive status epilepticus in adults. August 2022

10.   Strzelczyk A, Philipp Zollner, Willems LM. et al. Lacosamide in status epilepticus: Systematic review of current evidence. Epilepsia 2017;58(6):933-950

11.   Santamarina E, Gonzalez-Cuevas M, Toledo M. et al. Intravenous lacosamide (LCM) in status epilepticus: Weight-adjusted dose and efficacy. Epilepsy and Behaviour 2018;84:93-98