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There is no evidence that absence status induces neuronal damage, and thus aggressive
treatment is not warranted. Treatment can either be intravenous or oral. Absence status
epilepticus is often precipitated by the prescription of inappropriate AEDs in idiopathic
generalised epilepsy (e.g. carbamazepine). Absence status epilepticus responds rapidly to
intravenous benzodiazepines, and these are so effective that the response is diagnostic.
Lorazepam at 0.050.1 mg/kg is the benzodiazepine of choice. The effect may only be
transient and a longer acting AED may need to be given. If intravenous treatment is required,
but either benzodiazepines are ineffective or contraindicated then intravenous valproate
(2040 mg/kg) can be given. In cases of primary generalised epilepsy treatment should be
continued with a suitable AED. If a precipitating factor can be identified in late-onset de novo
cases, then long-term therapy is not usually indicated.

Complex partial status epilepticus
Complex partial status epilepticus has to be differentiated not only from other forms of non-
convulsive status epilepticus, but also from post-ictal states, and other neurological and
psychiatric conditions. EEG can be helpful, but often the scalp EEG changes are non-specific
and the diagnosis is very much clinical in nature. The definition as ‘a prolonged epileptic
episode in which focal fluctuating or frequently recurring electrographic epileptic discharges,
arising in temporal or extratemporal regions, result in a confusional state with variable
clinical symptoms’ is suitably vague and is necessary to emphasise that complex partial status
epilepticus can originate in any cortical region and can fluctuate in a cyclical fashion. A
further factor is importantly included in this definition, and that is the absence of coma;
electrographic status epilepticus in coma is considered separately, partly because of its poor
prognosis.

How aggressively complex partial status epilepticus should be treated depends upon: the
prognosis of the condition; and whether treatment improves the prognosis. As in all epilepsies
the prognosis relates partly to the prognosis of the underlying aetiology and any concomitant
medical conditions. Complex partial status epilepticus in someone with epilepsy is probably
a more benign condition than acute precipitated status epilepticus, and should perhaps be
treated thus. The medication used to treat status epilepticus is not without adverse effects and
can result in hypotension, respiratory depression and, sometimes, cardio-respiratory arrest.
This is more so with intravenous administration with its resultant rapid, high serum levels.
At present, early recognition of the condition and treatment with oral or rectal
benzodiazepines is recommended; oral clobazam has proven to be an effective treatment. In
patients who have repetitive attacks of complex partial status epilepticus, oral clobazam
(1020 mg/day) over a period of 23 days given early at home can usually abort the status
epilepticus, and such strategies should be discussed with patient and carers.

Early recognition is a critical goal, as the delay in treatment comes not from therapeutic
strategy, but from failure to diagnose the condition in the first place. For more persistent or
resistant complex partial status epilepticus intravenous therapy should be used, and
lorazepam followed by phenytoin are the drugs of choice. In contrast to absence status
epilepticus, the response to benzodiazepines can be disappointing, and often there is a
resolution of the electrographic status epilepticus without concomitant clinical improvement
(possibly due to post-ictal effects). Whether general anaesthesia is ever justified remains a
matter for speculation; since most complex partial status epilepticus is self-terminating often
without any serious neurological sequelae, then such aggressive therapy should, in most
instances, be avoided. Treatment of the underlying cause (e.g. encephalitis or metabolic
derangement) is of course paramount, and can often lead to resolution of the status
epilepticus.