Status EpilepticusDefinition

1
Status Epilepticus-Definition

• 1. Major motor (convulsive) status
• Three(3) seizures uninterrupted by
  consciousness or a single prolonged
  seizure greater than 1/2 hour.
• 2. Spike wave stupor (Absence or Petit mal
  status) and complex partial (psychomotor) status
  are prolonged alterations of consciousness
  verified by EEG as epileptic.

2
Status epilepticus

• It is a medical emergency requires prompt and
  aggressive treatment
• Therapy should be aimed at
• Rapid termination of status epilepticus
• Prevention of seizure recurrence
• Treatment of underlying cause

3
Status Epilepticus - Treatment

• Immediate treatment
• 1. Secure IV line draw blood for analysis
  (including anticonvulsant levels).
• 2. Push 50 cc of 50 Dextrose i.v.,
• 100mg thiamine i.v.
• 3. Monitor vital signs.
• 4. Examine patient.
• 5. Protect airway, tongue, head, never leave
  patient alone
• 6. Intubate all patients if first line drugs
  fail.

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Status Epilepticus - Definite Treatment

• Non-specific
• Correct electrolyte imbalance - acidosis lowers
  seizure threshold, treat with bicarbonate if
  pHlt7.1
• Lower fever
• Antibiotics/ LP if indicated
• If neurologic exam dictates, treatment of
  underlying cause may proceed concurrently with
  drug therapy, e.g., neurosurgical decompression.
• Hypotension maintain BP

5
Status Epilepticus-Definitive Treatment

• Diazepam - 10mg IV push over 30-60
  seconds repeat after 10-15mins upto 30mg
  (5mg/min) Repeat after
  2-4hrs. 100mg/day
• i.Good results, easy to administer.
  (fast acting, short lasting)
• ii. If two doses fail to stop status,
  then further doses probably won't work either.
• iii. Side effects -- hypotension,
  bradycardia, respiratory depression, cardiac
  arrest, depresses mental status.

6
OR Lorazepam - 4 mg IV push (2mg/min)
may be repeated. i. Fast acting, medium
lasting. ii. Respiratory depression only in
the extubated patient.
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Status Epilepticus-Definite Treatment

• b. Phenytoin - 12-20mg/kg IV (slow IV push)
  (50mg/min) fast and long acting.
• i. Presently used concomitantly with a
  benzodiazepine
• ii. Its pH is 12, all i.v. fluids are pH
  4-6. Do not add to dextrose drip as it
  preciptiates.
• iii. Monitor BP and ECG

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• IV Valproate - 25 mg/kg IV push, may repeat.
• i. Generally not used because of lack of
  experience. Good results in both major motor and
  absence status.
• ii. fast acting, long acting.
• iii. Far less side effects than
  Diazepam and dilantin especially in unstable
  cardiac status, hypotension, hepatic failure etc.

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Status Epilepticus - Definite Treatment

• Other drugs that can be used
• IV Midazolam, IM fosphenytoin
• IM paraldehyde
• In children and when venous access unavailable,
  rectal diazepam, lorazepam, midazolam or
  paraldehyde.
• IV thiopentone, IV lignocaine, IV propofol.
• Neuro muscular blocking agents