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
For how long can a patient be treated for status epilepticus before anaesthetist is required?
20 minutes
If a seizures goes on after 60 minutes despite initial lorazepam and phenytoin what may be needed?
Anaesthetic intervention to paralyse with propofol and ventilate with continuous EEG in ICU
What treatment is available for status epilepticus caused by alcoholism?
Thiamine 250mg IV over 30 mins
If glucose levels are abnormally low in status epilepticus what can be given?
Glucose 50ml 50% IV
What other physiological parameters may need addressing in status epilepticus?
- Acidosis
- Hypotension
What percentage of status epilepticus patients die within 30 days?
10-30%
What do the people who die within 30 days of status epilepticus tend to have?
Underlying brain condition causing seizures e.g. tumour or stroke
What are the acute complications of status epilepticus?
- Hyperthermia
- Pulmonary oedema
- Cardiac arrhythmias
- Cardiovascular collapse
What are the long term complications of status epilepticus?
- Epilepsy
- Encephalopathy
- Focal neurological deficits
