Status Epilepticus Flashcards
What is status epilepticus?
- A single seizure lasting more than 5 minutes
OR
- 2 or more within 5 minutes without return to normal in between
How was status epilepticus previously defined?
Over a period of 30 minutes
What are the two categories of status epilepticus?
- Convulsive
- Non-convulsive
What are the two types of non-convulsive status epilepticus?
- Prolonged complex partial seizures
- Absence seizures
What percentage of cases of status epilepticus are non-convulsive?
Up to 25%
What percentage of people who have seizures or status epilepticus have epilepsy?
25%
What are some other possible causes of status epilepticus or status epilepticus like-presentation (besides epilepsy)?
- Stroke
- Haemorrhage
- Intoxicants or adverse drug reactions
- Problems with anticonvulsants
What problems with anticonvulsants can lead to seizures or status epilepticus?
- Insufficient dosage
- Sudden withdrawal
- Alcohol consumption or withdrawal
- Starting a new medication that affects anticonvulsant
- Developed resistance
- Gastroenteritis
What are the risk factors for status epilepticus?
- <5 years or elderly
- Genetic predisposition
- Intellectual disability
- Structural brain pathology
How doe convulsive status epilepticus present?
A regular pattern of contraction and extension of the arms and legs
How does non-convulsive status epilepticus present?
A long duration change in a person’s level of consciousness without large scale bending and extension of limbs
What investigations should be performed after an episode of acute status epilepticus to try and determine an underlying cause?
- Anticonvulsant drug blood levels
- Toxicology screen
- Comprehensive metabolic panel
- FBC
What are the differentials for status epilepticus?
- Psychogenic non-epileptic SE
- Delirium
- Coma
What are the initial management steps for status epilepticus?
- Secure airway
- Give high flow O₂
- Gain IV access
What may be used to secure airway in status epilepticus?
Adjuncts
What should IV access be used for in management of status epilepticus?
1) . Bolus of Lorazepam
2) . Bloods
What dose of lorazepam is used initially in status epilepticus?
4mg
What bloods can be taken in acute status epilepticus?
- U&E
- LFT
- FBC
- Glucose
- Calcium
- Toxicology screen
- Anticonvulsant levels
How many times can lorazepam be given in status epilepticus?
No more than twice
When should a second dose of lorazepam be considered in status epilepticus?
If no response 10-20 minutes after the first
What can be used instead of lorazepam in status epilepticus if immediate IV access is not possible?
Buccal midazolam
If seizures continue after 2 doses of lorazepam what can be used in status epilepticus?
IV phenytoin 10mg/kg (max1g) at no more than 100mg/minute
What can be given after initial IV phenytoin dose in status epilepticus?
Maintenance 100mg phenytoin/6-8 hours
What should be monitored during treatment of status epilepticus with phenytoin?
- Blood drug levels
- ECG
- BP
