Convulsive status epilepticus is the second most common neurologic emergency, with an annual incidence of 10–40 cases per 100,000 people.[1,2] Morbidity and mortality are considerable, and thus, timely termination of convulsive status epilepticus is the primary goal of management to avoid these risks.[3–5] Benzodiazepines, typically lorazepam or diazepam, are used as first-line therapy for status epilepticus.[6–8] After benzodiazepines failed to terminate convulsive status epilepticus in about 40–60% of patients, phenytoin has traditionally been used as a second-stage treatment since the 1970s.[9] Current guidelines recommend phenytoin, levetiracetam, and valproate for the treatment of benzodiazepine-refractory status epilepticus, and only fosphenytoin (a precursor drug to phenytoin) is labeled by the Food and Drug Administration (FDA) for this indication in adults.[6–8] Further, evidence for this indication is sparse.
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