Status epilepticus

Question 1

Order of medications to try in status epilepticus. Move on if the previous medication fails to control seizures.

Answer 1

1. Lorazepam bolus
2. Second try of lorazepam bolus
3. Phenytoin or Fosphenytoin bolus (skip if already on one)
4. Phenobarbital bolus
5. Induce general anesthesia with thiopental, propofol, midazolam, phenobarbital, or isoflurane

Question 2

Medications known to reduce the seizure threshold

Answer 2

Antimicrobials: High dose penicillin, fluoroquinolones, imipenem, isoniazid, aztreonam

Psychiatric drugs: Buproprion, lithium, clozapine, flumenazil, phenothiazines

Anesthetics: Lidocaine, bupivacaine

Misc: Theophylline, cyclosporine, metrizamide (IV contrast)

Question 3

True seizures cause a small, but detectable, increase in serum ___

Answer 3

True seizures cause a small, but detectable, increase in serum prolactin

This can be used to help differentiate seizures from PNES. In order to be helpful, this must be taken within ~20 minutes of the seizure.

Question 4

In which scenarios of TBI is antiepileptic phophylaxis indicated?

Answer 4

Moderate to severe TBI