Status epilepticus Flashcards
Define: generalized convulsive status epilepticus (GCSE)
Any recurrent or continuous seizure activity, lasting longer than 30 minutes
Any seizure that does not stop within 5 mins should be treated aggressively as …..
impeding SE!
What is status epilepticus?
A life-threatening emergency!
What initiates a seizure? (what 2 categories?)
- Imbalance btwn excitatory
- Inhibitory neurotransmission
What are examples of imbalance btwn excitatory?
- Glutamate*
- Ca
- Na
- Substance p
- Neurokinin B
What are examples of inhibitory neurotransmission?
- γ-aminobutyric acid (GABA)*
- Adenosine
- K
- Neuropeptide Y
- Opioid peptides
- Galanin
Sustained depolarization can result in….
neuronal death
What is the major cause of GCSE?
- Glutamate acting on postsynaptic
- GABAA receptors may become less responsive to endogenous GABA & GABA agonists
Describe phase 1 of GCSE (impeding)
- Continuous seizures for at least 5 mins or 2 seizures w/out recovery btwn.
- Increases in epinephrine, norepinephrine, steroid
- Muscle contractions & hypoxia
Describe phase 2 of GCSE (established)
Begins 30 mins into seizure
- Decompensation
- Hypotension w/ compromised cerebral BF
- Glucose may be normal or decreased
- Hyperthermia, resp deterioration, hypoxia, & ventilatory failure
In prolonged seizures….
motor activity may cease, but electrical seizures may persist
Describe stage 3 of GCSE (refractory)
Continuous seizures despite tx w/ 2-3 AEDs
Describe phase 4 of GCSE (super-refractory)
Continue 24 hrs or longer after administration of anesthesia
How do you tx impeding GCSE (phase 1) ?
- Lorazepam
- Midazolam
What is 1st line tx for established GCSE (phase 2)?
Hydantoins
