Treatment of status epilepticus with diazepam

STATUS EPILEPTICUS constitutes a medical emergency, as well as a difficult problem of therapy. This statement has been made authoritatively and sufficiently frequent so that to belabor the point further is unnecessary (Gowers,l Clark,2 Turner,3 Wilson,4 and the more recent review of the problem by Hunter”. Two features of the problem seem worthy of stress here, as they do not seem to have received much attention in the literature. The first concerns the possible iatrogenic effects attributable to excessive treatment. In the emergency presented by status epilepticus, the tendency is often to overdose. A patient in status is likely to have dissipated much of his vital reserves and may more easily become a victim of the depressant effects characteristic for most, if not all, antiepileptic agents. The cardiac and respiratory centers and functions, already overburdened, are particularly vulnerable. In the course of an analysis concerned in establishing the immediate cause of death in patients that succumbed in status epilepticus at the Children’s Hospital Medical Center over a ten-year period, just short of a quarter of the total number was found to have had cardiac or respiratory arrest, or both, closely following the intravenous administration of a hypnotic agent.6 Further, there are some disquieting reports dealing with central nervous system lesions attributable to other nonbarbituric drugs, when administered parentally and in the large doses often used in status.?-9 It would seem, therefore, that a need still exists for drugs that would interrupt the vicious state of “continuous epilepsy” but would not be the source of equally dangerous iatrogenic effects. Such need has been obviously felt by many, as shown by the proposal to use intravenous urea, as advocated by Carter,lo or the intracarotid injections of amylobarbital, as advocated by Bladin.ll The other point needing clarification in a