Patients with a seizure disorder are commonly seen in the primary care setting. Some of these patients present with status epilepticus. The cardinal feature of status epilepticus is continuous or repeating seizures that occur so rapidly that the patient does not recover consciousness between them. Status epilepticus is a danger to the patient and a treatment challenge to the physician. Willmore reviews the treatment of epilepsy emergencies, with special emphasis on the management of patients with status epilepticus.

The author presents a timetable for the appropriate treatment of status epilepticus (see accompanying table). After the diagnosis has been confirmed, treatment is initiated with either acute emergency management or rational drug administration. Emergency care is designed to prevent injury, whereas drug treatment is guided by its ability to limit morbidity associated with systemic changes or seizure-induced neuronal damage.

The author concludes that the cause of status epilepticus must be determined in any patient who presents with this disorder. Investigations should include brain imaging studies to rule out any mass lesions or evidence of ventricular obstruction. If the patient is febrile and there is no evidence of mass lesions or ventricular obstruction, a lumbar puncture should be performed.