[EMed] Status Epilepticus

Question 1

what is generalised convulsive status epilepticus (GCSE)?

Answer 1

≥5 mins of continuous seizure activity OR ≥2 seizures without complete neurological recovery in between

Question 2

what is refractory status epilepticus?

Answer 2

continued seizures despite use of 2 anti-epileptic drugs (AEDs), one of which is a benzodiazepine

Question 3

how do you assess a pt with status epilepticus?

Answer 3

call help! (call ICU early)
A - nasopharyngeal airway (if needed)
B - high flow O2
C - IV access and take bloods, give fluids if hypotensive
D - check glucose, treat hypoglycaemia
E - look for precipitating cause

Question 4

what bloods would you send off for status epilepticus?

Answer 4

• VBG
• glucose
• renal fx
• U+Es incl. magnesium
• FBC
• AED levels
  +/- toxicology

Question 5

what do you monitor pts with status epilepticus for?

Answer 5

EEG monitoring for refractory status

primary end point = suppression of epileptic activity on EEG

Question 6

what is given in the community for status epilepticus?

Answer 6

buccal midazolam 10mg or rectal diazepam 10-20mg

Question 7

what is first given for mx status epilepticus?

Answer 7

IV Lorazepam 4mg
(repeated after 5-10 mins if needed)

concurrently IV load with non-benzodiazepine AED e.g. Valproate / Leviteracetam / Fosphenytoin

Question 8

what is given next if IV Lorazepam fails to stop the seizure?

Answer 8

IV Phenytoin 15-18mg/kg

or IV Fosphenytoin 15-20mg/kg +/- IV Phenobarbital 10-15mg/kg

Question 9

what do you do if the seizures are still ongoing despite use of 2 AEDs?

Answer 9

refractory status epilepticus → anaesthetic and intubation: IV midazolam / propofol / thiopentone sodium

Question 10

what are triggers for seizures in a pt with epilepsy?

Answer 10

• drug withdrawal, dose change or non-compliance
• intercurrent illness
• metabolic derangement
• drugs that lower the seizure threshold e.g. abx, aminophylline, tramadol

Question 11

can a pt with a class 1 licence (car/motorbike) with a single first seizure (provoked/unprovoked) drive?

Answer 11

must not drive for 6 months following seizure

Question 12

can a pt with a class 2 licence (bus/lorry) with a single first seizure (provoked/unprovoked) drive?

Answer 12

must be seizure free 5 years off medication

Question 13

can a pt with a class 1 licence (car/motorbike) with epilepsy or multiple unprovoked seizures drive?

Answer 13

must not drive 12 months from most recent seizure

Question 14

can a pt with a class 2 licence (bus/lorry) with epilepsy or multiple unprovoked seizures drive?

Answer 14

must be seizure free 10 years off medication

Question 15

when do alcohol withdrawal seizures usually occur?

Answer 15

12-48 hours after last alcoholic drink

Question 16

focal weakness after seizures. dx?

Answer 16

Todd’s Paralysis

Question 17

acute paralysis and dysarthria following rx for hyponatraemia. dx?

Answer 17

osmotic demyelination syndrome

Question 18

what is a common and reversible cause of seizure?

Answer 18

hypoglycaemia

Question 19

following seizure of any type, how long are pts unable to drive for?

Answer 19

at least 6 months

Question 20

what are the general causes of seizures?

Answer 20

• intra-cerebral
• metabolic
• substance misuse

Question 21

what are the intra-cerebral causes of seizures?

Answer 21

• intracerebral bleed e.g. trauma or stroke
• infection e.g. meningitis / encephalitis
• SOL e.g. abscess / tumour
• hypoxic-ischaemic injury

Question 22

what are the metabolic causes of seizures?

Answer 22

• hypoglycaemia
• hyponatraemia
• hypomangnesaemia
• hyperthyroidism

Question 23

what are the misused substances that cause seizures?

Answer 23

• alcohol / benzodiazepine withdrawal

- acute intoxication with cocaine / amphetamines