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Status Epilepticus-Definition

Status Epilepticus-Definition. 1. Major motor (convulsive) status Three(3) seizures uninterrupted by consciousness or a single prolonged seizure greater than 1/2 hour.

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Status Epilepticus-Definition

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  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.

  4. 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

  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.

  7. 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

  8. IV Valproate - 25 mg/kgIV 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.

  9. 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

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