When SE does not respond to treatment as expected, the clinician's attention should refocus along several lines:
- Is the diagnosis of SE correct?
- Has the underlying cause been correctly assessed? This is crucial, because SE is most likely to continue when trauma, hemorrhage, or infections such as encephalitis remain untreated.
- Have medications been given in adequate doses? (The 1000-mg standard phenytoin infusion may be insufficient, for example.)
- Have medications been adequately absorbed? Absorption can be a problem if there are difficulties with intravenous access or if the drug is given by another route.
- Has the SE recurred after successful treatment? This situation most often results from inadequate attention to maintenance levels of longer-acting anticonvulsants or lack of treatment of the underlying disease.
Reviewed and revised February 2004 by Thaddeus Walczak, MD, MINCEP® Epilepsy Care, Minneapolis, MN