This protocol applies when a patient with Dravet syndrome is in a prolonged convulsive seizure that has not stopped after a benzodiazepine and a full intravenous second-line antiseizure agent load. The target is complete cessation of the seizure.
The patient is in a prolonged convulsive seizure. Initial benzodiazepine therapy was given; a second-line intravenous agent was then loaded — yet the seizure continues. A further escalation step is required.
Treatment given: Intravenous valproate or intravenous levetiracetam load.
Goal not reached: Cessation of the convulsive seizure.
Because the seizure persists despite this step, the protocol below defines the appropriate next intervention.
When a prolonged convulsive seizure in Dravet syndrome continues after an intravenous valproate or levetiracetam load, an additional intravenous antiepileptic agent — of a different class — is the indicated next step. The full regimen, agent selection, and administration details are in the complete protocol.
Cessation of the convulsive seizure.
For prolonged convulsive seizures that persist despite benzodiazepines, either intravenous valproate or levetiracetam should be the next therapeutic choices (Strong).
Intravenous phenytoin or fosphenytoin could be considered after these agents if the seizure persists (Strong).
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