Combined Ketamine and Midazolam for Generalized Convulsive Status Epilepticus

Inclusion Criteria: * Age from 6 month to 16 years. * Generalized convulsive status epilepticus, defined as \> 5 minutes of clinically observed continuous or recurrent generalized, tonic-clonic seizure activity without regaining of consciousness. Exclusion Criteria: * Failure to obtain informed consent. * Previous treatment with any antiseizure medication for the presenting seizure episode. * Hypertension * Alcohol intake * Conditions associated with increased intracranial pressure (e.g., central nervous system mass lesions, hydrocephalus) * Glaucoma * Known allergy or contraindications to any of the study drugs. * End-stage kidney disease. * End stage liver disease * Arrhythmia, severe heart disease, or pulmonary hypertension. * Hyperthyroidism * Pheochromocytoma * Hypoglycemia or hyperglycemia. * Inborn errors of metabolism. * Known or suspected psychiatric disorder. * Failure to obtain intravenous access in the first 5 minutes of stabilization phase. * Cessation of seizures during the stabilization phase (0 - 5 minutes). * Traumatic brain injury.