21. Status epilepticus

Question 1

Definition status epilepticus

Answer 1

Seizure lasting for more than 5 minutes or recurrent seizures where consciousness is not regained (for more than 30 min)

Question 2

Epilepsy definition

Answer 2

Chronic neurological disorder which is predisposed to seizures
Seizures = episodic + high frequency firing of cortical neurons –> overactivity of neurons

Question 3

Categorisation of status epilepticus

Answer 3

Convulsive
- generalized (loss of conciousness): GTK, tonic, clonic, myoclonic
- focal: simple (wo. loss of conciousness) and complex

Non-convulsive
- absent

Question 5

Causes of status epilepticus

Answer 5

• Abrupt withdrawal of anti-epileptic drugs/too low dose of anti-epileptic drugs
• CNS infection
• Alcohol withdrawal
• Drug toxicity
• Hypoglycemia
• Electrolyte disturbance
• Acute cerebral embolization

Question 6

Diagnostic aspect of status epilepticus

Answer 6

Clinical signs –> start therapy immediatly even before EEG

Termination must be confirmed by EEG (due to non-convulsive)

EEG will also show the effect of treatment + level of anesthesia in those requiring it

Question 7

Complications of status epilepticus

Answer 7

• Cerebral edema
• Permanent brain damage
• Rhabdomyolysis
• Cardiovascular failure

Question 8

Treatment of status epilepticus

Answer 8

1. ABC + glucose and electrolytes
2. IV diazepam/lorazepam: if not IV line = give midazolam IM/buccal
3. IV phenytoin/valproic acid/levetiracetam
4. IV propofol or phenobarbital = general anesthesia/barbiturate narcosis