Status Epilepticus

Question 1

Status Epilepticus Definition

Answer 1

Seizure that lasts longer than 5mins, or when convulsive seizures occur one after the other with no recovery

Question 2

Status Epilepticus Differentials

Answer 2

Non-epileptic seizures

-physiological, psychogenic

Question 3

Status Epilepticus Management in Community

Answer 3

• General protective measures, head protection
• Secure airway and assess respiratory and cardiac function
• Buccal midazolam as first-line treatment, rectal diazepam if preferred
• IV lorazepam if IV access can be established

Question 4

Status Epilepticus Management in Hospital

Answer 4

• Secure airway give high flow oxygen
• Monitor obs and ECG
• Check and correct blood glucose (could be cause)
• Lorazepam 4mg IV is first line treatment, IV diazepam if lorazepam unavailable
• Repeat lorazepam after 10 minutes if no response
• Buccal midazolam is unable to secure immediate IV access, max 2 doses of first line treatments
• If seizures continue, call ICU, phenytoin IV
• If refractory; IV midazolam, propofol or thiopental
• Correct hypoglycaemia, parenteral thiamine if alcohol abuse suspected, pyridoxine if status epileptics caused by pyridoxine deficiency

Question 5

Status Epilepticus Ix

Answer 5

• Pulse oximetry, blood gases
• Full bloods
• Save urine sample for toxicology

Question 6

Status Epilepticus Further Management

Answer 6

-Identify and treat underlying cause, identify complications, regular AED

Question 7

Status Epilepticus (Non-Convulsive) Management

Answer 7

• (Absence, focal seizures)
• Less common and less severe
• Reinstate AEDs
• Consider benzodiazepine
• IV benzodiazepines under EEG
• Refer for specialist advice