| Applies to: Patients with rhythmic or periodic focal or generalized epileptiform discharges on EEG with neurological impairment |
| Monitoring: EEG, pulse oximetry, blood pressure, ECG, respiratory rate with dedicated nurse |
| Antiseizure medication trial: |
| Sequential doses of a rapidly-acting IV antiseizure medication (eg, fosphenytoin 10 mg/kg, valproate 20 mg/kg, levetiracetam 20 mg/kg, brivaracetam 100 to 200 mg, or lacosamide 200 mg) or a short-duration benzodiazepine (eg, midazolam at 1 mg/dose) |
| Between doses, repeated clinical and EEG assessment |
Trial is stopped after any of the following: - Persistent resolution of the EEG pattern (and exam repeated)
- Definite clinical improvement
- Respiratory depression, hypotension, or other adverse effect
- A maximum dose is reached (such as 0.2 mg/kg midazolam, although higher doses may be needed if the patient is on chronic benzodiazepines)
|
| Test is considered positive if there is resolution of the potentially ictal EEG pattern AND either an improvement in the clinical state or the appearance of previously-absent normal EEG patterns (eg, posterior dominant "alpha" rhythm). If EEG improves but patient does not, the result is equivocal. A negative test does not rule out NCSE. |
