Management of status epilepticus includes stabilization of airway, breathing, and circulation. If a patient is obtunded or unable to protect the airway, endotracheal intubation is indicated. Following stabilization, pharmacologic therapy should be initiated with first-line therapy of a benzodiazepine, such as lorazepam. Appropriate dosing is associated with seizure termination and reduced complications.16-18 Antiepileptic medication may be administered concurrently, such as fosphenytoin, phenytoin, levetiracetam, or valproic acid.19-22 Refractory status epilepticus may be treated with a continuous infusion of antiepileptic medication, such as propofol, ketamine, midazolam, or pentobarbital.
Consultation with neurology should be sought to guide therapy. Patients with status epilepticus require hospital admission, often to an intensive care setting.
Disclaimer: This article is not a comprehensive review of diagnosis and treatment of status epilepticus, but an overview of management and future directions. Authoritative sources should be used for diagnostic and treatment decisions. The opinions expressed above are not those of the American College of Emergency Physicians.
Dr. Marco is a professor of emergency medicine at Penn State Health—Milton S. Hershey Medical Center at Penn State College of Medicine and an assistant editor of ACEP Now.
References
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One Response to “Point-of-Care EEG Is Not Ready for Prime Time”
August 2, 2026
Rick Kozak, MDDear Dr Marco,
I read your response from the ACEP Now Editorial Team entitled Point -of-Care EEG: Not Ready for Prime Time. Your comments appear to support the use of POC-EEG in the emergency department. Other than the future directions and questions to be answered, which are issues actively being studied and written about , each of your paragraphs supports emergency physicians utilization of POC-EEG. Dr Smart is missing the point that a brain can be seizing while motor clues are absent and therefore we need to educate emergency physicians on the use of devices to allow appropriate treatment quickly. The definition of non-convulsive status epilepticus definition is debated by epileptologists but also defined by them “in concesus”. Her last sentence then describes what the POC-EEG is being used for in facilities that have it. I might be overstepping, but does your final concern about unintended consequences suggest that POC-EEG might delay treatments like airway protection? I doubt that an emergency physician would do that. Would you hypothesize that an emergency physician would under-medicate patients who need anti-seizure medications(ASMs) if the EEG reads “zero seizure burden”? What I see at facilities that utilize POC-EEG are emergency physicians quickly giving the high dose benzodiazepines knowing it will lead to intubation and adding second line ASMs quickly when they are responding to device feedback. I also see patients who are afforded more time to wake up and subsequently go home when there prolonged post ictal period is monitored and ASM escalation is avoided.
I am collaborating to write research protocols for investigator-initiated research and believe that funding should be available from federal agencies to untie conflicts of interest.
Respectfully,