First-line treatment for rapid control of status epilepticus in adults is immediate administration of a benzodiazepine. This can be buccal midazolam or rectal diazepam if intravenous access is not available, or intravenous lorazepam if intravenous access and resuscitation facilities are immediately available.
Second-line treatment is indicated if seizures do not respond to two doses of benzodiazepines. Intravenous administration of one of the following antiseizure medications is recommended: levetiracetam, phenytoin, or sodium valproate. Levetiracetam may be preferred due to quicker administration and fewer adverse effects, although its use was off-label as of April 2022.
Third-line treatment options, under expert guidance, include phenobarbital or general anaesthesia if status epilepticus is refractory to second-line treatments.