Repeated or cluster seziures, prolonged seizures, status epilepticus & febrile convulsions

Question 1

define repeated or cluster seziures

Answer 1

typically 3 or more self-terminating seizures in 24 hours

Question 2

what is status epilepticus and why is it a medical emergency

Answer 2

Status epilepticus, defined as a seizure that lasts 5 minutes or longer, or recurrent seizures without recovery in between, should be managed as a medical emergency to prevent neurological injury and death.

Question 3

causes of convulsive status epilepticus

Answer 3

Causes of status epilepticus include poorly-controlled epilepsy (therapy non-adherence or withdrawal), eclampsia, metabolic abnormalities, alcohol or drug withdrawal, infection such as CNS infections, a tumour, airway obstruction, hypoxia, and shock.

Question 4

define prolonged convulsive seizures

Answer 4

a seizure that continues for more than 2 minutes longer than the patient’s usual seizure

Question 5

what is convulsive status epilepticus

Answer 5

a seizure that lasts for 5 minutes or more

Question 6

Repeated or cluster seizures, prolonged seizures, and status epilepticus should be managed as …

Answer 6

a medical emergency

Question 7

what to do if a pt has repeated or cluster seizures, or prolonged convulsive seizures

Answer 7

• follow their individualised emergency management plan, if immediately availavle
• if not available, consider urgently treating with BZPN (e.g. clobazam, midazolam)

Question 8

what to do for convulsive seizures that continue for 5 mins or more

Answer 8

follow recommendations for convulsive status epilepticus

Question 9

if there is a concern that repeated or cluster seizures, or prolonged seizures (convulsive or non-convulsive) may recur, what should be agreed with the pt

Answer 9

an emergency management plan should be agreed with the patient if they do not have one already.

Question 10

immediate measures to manage status epilepticus

Answer 10

positioning the patient to avoid injury
supporting respiration including the provision of oxygen
maintaining blood pressure
correction of any hypoglycaemia

The immediate management of convulsive status epilepticus includes securing the patient’s airway, giving oxygen, and monitoring cardiac and respiratory function.

Question 11

In patients with established epilepsy, how can you find out if non adherence is a cause

Answer 11

In patients with established epilepsy, obtaining serum-antiepileptic concentrations can determine if non-adherence is a cause, and may inform treatment doses.

Question 12

what to consider in consulsive status epilepticus if alcohol abuse suspected

Answer 12

parenteral thiamine

Question 13

what to give if convulsive status epilepticus is caused by pyridoxine deficiency

Answer 13

give pryidoxine HCl

Question 14

treatment of convulsive status epilepticus

Answer 14

• follow pt individualised emergency management plan if immediately available
• if not available, treat pt urgently with buccal midazolam or rectal diazepam in the community
• if IV acccess and resuscitation facilities are immediately available, can use IV lorazepam

Question 15

when can you use IV lorazepam for treatment of convulsive status epilepticus

Answer 15

If intravenous access and resuscitation facilities are immediately available

Question 16

status epilepticus - treatment is follow indivualised emergency plan; if not available then urgently treat with buccal midazolam or rectal diazepam in the community, or IV lorazepam if intravenous access and resuscitation facilities are immediately available.

If there is no response to first dose of BZDPN, what do you do?

Answer 16

call emergency services in community or seek expert advice in hospital
continue to follow pt plan if available OR give 2nd dose of BZDPN if seizure does not stop within 5-10 mins of first dose

Question 17

convulsive status epilepticus - what to do if there is no response to two doses of BZDPN

Answer 17

• 2nd line treatment options include levet, phenytoin, or SV
  levetiracetam may be quicker to give and has fewer side-effects
• if it does not respond to a second line treatment, consider alternative 2nd line option under expert advise
• under expert advice, if 2nd line treatment options unsuccessul, 3rd line may include phenobarbital or GA

Question 18

if there is concern that status epilepticus may recur, the following needs to be agreed

Answer 18

an emergency management plan should be agreed with the patient if they do not have one already

Question 19

urgency to treat non convulsive status epilepticus depends on

Answer 19

severity of pt condition

Question 20

non consulsive status epilepticus - what to do if there is incomplete loss of awareness

Answer 20

usual oral antiepileptic therapy should be continued or restarted

Question 21

non consulsive status epilepticus - what to do if pt who have incomplete loss of awareness fail to resond to oral antiepileptic therapy or have complete lack of awareness?

Answer 21

Patients who fail to respond to oral antiepileptic therapy or have complete lack of awareness can be treated in the same way as for convulsive status epilepticus, although anaesthesia is rarely needed

Question 22

Treatment of brief febrile convulsions

Answer 22

need no specific treatment; antipyretic medication (e.g. paracetamol), is commonly used to reduce fever and prevent further convulsions but evidence to support this practice is lacking

Question 23

how to treat prolonged febrile convulsions (those lasting 5 minutes or longer), or recurrent febrile convulsions without recovery

Answer 23

treat actively (as for convulsive status epilepticus)

Question 24

Long-term anticonvulsant prophylaxis for febrile convulsions is …. indicated.

Answer 24

rarely

Question 25

convulsive (Including febrile) seziures lasting longer than 5 mins - when can you repeat dose of BZDPN

Answer 25

repeat once after 5-10 mins if necessary