The treatment of status epilepticus is a task for skilled physicians, not for parents. But we’re sure that you would like to know what the physicians are doing and why. First, they will take your child into a special place in the emergency room to make sure that he is breathing properly. They may give him oxygen by mask, suction saliva out of the throat, and observe him for a few minutes to see the seizures. While they are observing, they will draw some blood to check for infection and to check for the level of blood sugar and other chemicals in the body that could be out of balance and causing seizures. If your child has previously had seizures and is taking medicine, the physicians will want to check the blood for the level of the anticonvulsants. They may also check for any drugs or medications taken accidentally. They will start an intravenous line (IV) to introduce fluids and so that they can give anticonvulsant medications into the vein if necessary. Intravenous is the best way to give medications when a child is continuing to have seizures, because it is the most rapid way to get the medicine to the brain to stop the seizures. All of these things should take place in the first several minutes after arrival in the emergency room.

During this time the medical team also will take a brief history, searching for reasons for the status. They will be particularly concerned about any current illness, because meningitis or encephalitis, which could be a cause of the seizures, would require prompt treatment. The medical staff will want to know from you if the child has ever had seizures before, if there possibly has been an injury to the head, and things like that. Anything that you could think of that might have led the child to have a seizure at this particular time could be of help to the physicians.

If the seizures have been continuing more than fifteen, twenty, thirty minutes, the physicians will want to give medication to stop them. Various medications may be used, but drugs like diazepam (Valium) or lorazepam (Ativan), quick-acting effective anticonvulsants, are used initially. Unfortunately, although they work quickly, they often do not continue to work over a long period of time, and when they wear off— in ten to twenty minutes, or longer in the case of lorazepam—another seizure may occur. Therefore, the physician usually will give an additional drug, such as phenytoin (Dilantin), which works less quickly than the other but lasts longer.

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