Status Epilepticus

Introduction

o Status epilepticus (SE) is a life-threatening condition where there is 5 minutes or more of continuous seizure activity or repetitive seizures without regaining consciousness.
o SE can occur in patients without epilepsy.
o Epileptic patients with partial refractory seizures are more likely to have SE.
o There are many causes of SE (similar to the causes of epilepsy).
o The most common cause is non-adherence to anticonvulsant medication.

Presentation

o Prolonged seizure activity with or without convulsions

History

o Alcohol/Drug abuse?
o Compliance with anticonvulsant medication?
o Recent brain insult?
• Head trauma
• Stroke
• Infection
• Vital signs
o Low oxygen saturation

Examination

o See epilepsy
o Anticonvulsant drug blood level

Laboratory investigations

o See epilepsy

Radiological investigations

o See epilepsy

Special investigations

o See epilepsy

Management

o In the community the patient should be given buccal midazolam or rectal diazepam.
o If there is no response then rapid admission to hospital is essential.
o The patient’s airway needs to be secured.
o High-concentration oxygen should be given.
o Cardiac and respiratory function should be assessed.
• ECG monitor.
o Assess blood glucose levels
o Gain intravenous access
• If cannot be gained initially, give buccal midazolam or rectal diazepam (maximum 2 doses including pre-hospital dose)
o Administer intravenous (IV) lorazepam 0.1mg/kg (maximum 4mg/dose) at a rate of 2mg/minute. If ineffective a second dose (maximum 8mg) should be administer in 10-15 minutes.
o If seizures continue, give IV phenytoin (20mg/kg at a rate less than 50mg/min as a loading dose, followed by a second dose of 5-10mg/kg) or phenobarbital (20 mg/kg intravenously at a rate less than 50-75 mg/min as a loading dose, followed by a second dose of 5-10 mg/kg)
o If seizures continue, patient should be placed under general anaesthesia.
• The patient should be ventilated and transferred to intensive care.
o It is important to seek anaesthetist/intensivist advice early as the treatment pathway progresses.

Complications

o Focal neurological deficits
o Cognitive dysfunction
o Behavioural problems
o Death

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