Epilepsy Free

ENGEL Classification
Epilepsy surgery outcome categorization
Class I

Free of disabling seizures

  1. Completely seizure free since surgery
  2. Non-disabling simple partial seizures only since surgery
  3. Some disabling seizures after surgery for at least 2 years
  4. Generalized convulsions w/ AED discontinuation only
Class II

Rare Disabling Seizures (almost seizure free)

  1. Initially free from disabling seizures, still with rare seizures
  2. Rare disabling seizures since surgery
  3. Occasional disabling seizures since surgery, but rare seizures for the last 2 years
  4. Nocturnal seizures only
Class III

Worthwhile improvement

  1. Worthwhile reduction in seizure frequency
  2. Prolonged seizure-free intervals amounting to greater than 50% of follow-up period, but not less than 2 years
Class IV

No Worthwhile Improvement

  1. Significant seizure reduction
  2. No appreciable change
  3. Seizures worse
Initial Steps for Status Epilepticus Therapy (Adult)
AED Step Description
1st Line Lorazepam 0.1mg/kg IV @ <2mg/min
2nd Line

Give either simultaneously with above or 1 minute after lorazepam infusion completes:

  1. phenytoin 20mg/kg IV @ <50mg/min
  2. phosphenytoin 20mg/kg IV @ <150mg/min
3rd Line

7% chance of success at stopping seizure:

  1. phenobarbital <20mg/kg IV @ <100mg/min
  2. valproate 15-30mg/kg IV @ <6mg/kg/min
  3. levetiracetam 20mg/kg IV in 15min
Consider: skip 3rd line → intubate → start midazolam, pentobarbital or propofol

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