Monitoring

For patients with convulsive status epilepticus, start regular monitoring (in the first 5 minutes from presentation), which may include:

  • Neurological observations. Use the Glasgow Coma Scale (GCS) [ Glasgow Coma Scale Opens in new window ]

    • If GCS score ≤8 (i.e., patient not obeying commands, not speaking, not eye opening) request an urgent review by the intensive care team for appropriate airway management[32]

  • Pulse[16]

  • Blood pressure[16]

  • Temperature[16]

  • ECG[27]

  • Biochemistry, blood gases, clotting, blood count[16]

  • Anticonvulsant levels.[16]

Seek advice from the neurology team to guide decisions on which anticonvulsant concentrations to monitor regularly.

  • The National Institute for Health and Care Excellence in the UK recommends to consider monitoring of anticonvulsant drug levels during treatment for status epilepticus.[1] However, in practice this is not done routinely. This is because anticonvulsant drug concentrations may exceed the published target concentrations. Bear in mind that regular monitoring may be useful to confirm adequate levels of anticonvulsant before an agent is considered ineffective in patients with refractory status epilepticus.

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