Epilepsy: Continuum (Epilepsy Emergencies)

Question 1

Time that normal inhibitory mechanisms should stop seizure activity.

Answer 1

3-5 minutes.

Question 2

Incidence of Status Ep.

Answer 2

Bimodal (10 and 50)

Question 3

3 etiologies for excitation

Answer 3

established epileptogenic circuit, structural lesion, toxic/metabolic derangement.

Question 4

Anatomical stucture that is the “brake” for seizures

Answer 4

Dentate

Question 5

MRI (DWI) finding after focal status

Answer 5

cortical ribboning.

Question 6

Pathophysiologic changes that occur with recurrent sezirues

Answer 6

GABA receptors are endocytosed and glutamate receptors are recruited.

Question 7

What is non-convulsive states q

Answer 7

Usually the burnt out stage of convulsive status with only subtle twitches and eye movements remaining

Question 8

Risk of status in comatose patient

Answer 8

30-40%

Question 9

If infection is suspected as a cause of status what should you do ?

Answer 9

get a lumbar puncture

Question 10

Medication algorithm for status

Answer 10

Ativan –> fosphenytoin –> intubate (Etomidate/Roc) –> midazolam/pentobarb/propofol

Question 11

If 3rd line med is needed what do you titrate this to on EEG ?

Answer 11

Burst suppression.

Question 12

Ativan loading dose, maintenance dose, and half-life

Answer 12

0.1 mg/kg at a rate of 2mg/min. 0.1-2 mg/kg/h

12 hours.

Question 13

Midazolam loading dose and hlaf life

Answer 13

0.2 mg/kg (10mg IM) for 2-6 hours

Question 14

Fosphenytoin loading dose, maintenance dose, and half life.

Answer 14

20mg/kg at a rate of 150mg. 100mg q6h. 10-15 hours

Question 15

Valproate loading dose, maintenance dose, and half life

Answer 15

20-40 mg/kg, 4-6 mg/kg 16h, 9-16 hours.

Question 16

When is midazolam less effective ?

Answer 16

with prolonged use and with recurrent seizures d/t degradation of GABA receptors.

Question 17

Two phases to try weaning off third line

Answer 17

24-48 hours. if seizure recurs 3-7 days.

Question 18

What percent of status involves an acute symptomatic etiology

Answer 18

50%

Question 19

60% of patient’s who experience < __ hours of NCSE will return home non-disabled.

Answer 19

10 hours