Status Epilepticus Flashcards
What is status epilepticus (SE)?
Continuous seizures lasting more than 5 minutes or intermittent seizures without full recovery over a period of 5 minutes
What is crucial in treating SE?
Terminating seizures as soon as possible
Why is early seizure termination important?
Longer seizure duration is associated with worse outcomes
How do prolonged seizures respond to treatment compared to short seizures?
They are more resistant to treatment
What causes seizures?
Rapid abnormal electrical discharges from cerebral neurones
How may seizures present clinically?
Involuntary alterations in consciousness and/or motor activity
What happens to facilitate SE?
Failure of normal factors that act to terminate atypical neuronal activity
What changes can lead to failure of seizure termination?
- Changes in GABA receptor composition
- Loss of benzodiazepine efficacy
- Excessive glutamate excitation
- Activation of drug resistance genes
What are prolonged seizures associated with?
- Cerebral hypoxia, hypoglycaemia and hypercapnia
- Progressive lactic and respiratory acidosis
What can occur as a result of cerebral hypoxia and hypoglycaemia?
Cerebral metabolic needs may exceed the available oxygen and glucose
What will happen if the cerebral metabolic needs exceed available oxygen and glucose?
Potentially irreversible neuronal destruction
What can cause SE?
- Meningitis
- Head injury
- Altered drug therapy in epileptic
- Non-compliance in a known epileptic
- Metabolic disturbances
- ‘Febrile status’
- Poisoning
What are the different types of SE?
- Simple partial
- Complex partial
- Absence
- Non-convulsive
- Myoclonic
What blood tests should be performed on a person with SE?
- Blood gases
- Glucose
- Renal and lifer functions
- Calcium
- Magnesium
- FBC
- Clotting
- AED drug levels
What samples should be taken for future analysis in SE?
- 5ml blood
- 50ml urine
If suspecting aspiration during seizure what should be performed?
CXR
What are other investigations dependant on?
Clinical picture
What additional investigations may be considered?
- LP
- CT head
What are the differentials for SE?
Psychogenic non-epileptic SE
What should be done as soon as someone begins having a seizure?
- Maintain airway
- Give high flow oxygen
- Check glucose
What should be done if a seizure has not stopped after 5 minutes?
- If IV access readily available give IV lorazepam
- If NOT, give buccal midazolam or rectal diazepam
What should be done if a seizure has not stopped after 15 minutes?
- IV lorazepam
- Call senior help
- Prepare phenytoin to confirm if epileptic seizure
What should be done if a seizure has not stopped after 25 minutes?
- Ensure senior help is present
- Seek anaesthetic/ICU advice
- Consider rectal paraldehyde
- IV phenytoin over 20 mins or if on phenytoin give phenobarbitone IV over 5 mins
What should be done if a seizure has not stopped after 45 minutes?
Rapid sequence induction of anaesthesia with thiopental with anaesthetist present
What should be monitored in patients who have experienced status epilepticus?
- Regular neuro obs
- Pulse, BP and temp
- ECG
- Biochemistry
- Blood gases
- Clotting
- Blood count
- Drug levels
What do patients undergoing SE require?
Full ITU facilities
Who is responsible for the care of a patient with SE?
Neurologist and anaesthetist
When is EEG monitoring required?
In patients with refractory SE
What are the potential complications of SE?
- Motor and cognitive sequelae
- Hippocampus sclerosis
What can hippocampus sclerosis lead to?
Chronic recurrent and refractory complex partial seizures
