Transcript Document

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.
Status epilepticus
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It is a medical emergency – requires prompt and
aggressive treatment
Therapy should be aimed at:
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Rapid termination of status epilepticus
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Prevention of seizure recurrence
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Treatment of underlying cause
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.
Status Epilepticus - Definite Treatment
Non-specific
 Correct electrolyte imbalance - acidosis lowers
seizure threshold, treat with bicarbonate if pH<7.1
 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
Status Epilepticus-Definitive Treatment
a.
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.
OR
Lorazepam - 4 mg IV push (2mg/min) may
be repeated.
i. Fast acting, medium lasting.
ii. Respiratory depression only in the
extubated patient.
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
d. 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.
Status Epilepticus - Definite Treatment
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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