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Status Epilepticus-Definition 1. Major motor (convulsive) status 1. Major motor (convulsive) status Three(3) seizures uninterrupted by consciousness or.

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Presentation on theme: "Status Epilepticus-Definition 1. Major motor (convulsive) status 1. Major motor (convulsive) status Three(3) seizures uninterrupted by consciousness or."— Presentation transcript:

1 Status Epilepticus-Definition 1. Major motor (convulsive) status 1. Major motor (convulsive) status Three(3) seizures uninterrupted by consciousness or a single prolonged seizure greater than 1/2 hour. Three(3) seizures uninterrupted by consciousness or a single prolonged seizure greater than 1/2 hour. 2. Spike wave stupor (Absence or Petit mal status) and complex partial (psychomotor) status are prolonged alterations of consciousness verified by EEG as epileptic. 2. Spike wave stupor (Absence or Petit mal status) and complex partial (psychomotor) status are prolonged alterations of consciousness verified by EEG as epileptic.

2 Status epilepticus It is a medical emergency – requires prompt and aggressive treatment It is a medical emergency – requires prompt and aggressive treatment Therapy should be aimed at: Therapy should be aimed at: Rapid termination of status epilepticus Rapid termination of status epilepticus Prevention of seizure recurrence Prevention of seizure recurrence Treatment of underlying cause Treatment of underlying cause

3 Status Epilepticus - Treatment Immediate treatment 1. Secure IV line draw blood for analysis (including anticonvulsant levels). 1. Secure IV line draw blood for analysis (including anticonvulsant levels). 2. Push 50 cc of 50% Dextrose i.v., 2. Push 50 cc of 50% Dextrose i.v., 100mg thiamine i.v. 100mg thiamine i.v. 3. Monitor vital signs. 3. Monitor vital signs. 4. Examine patient. 4. Examine patient. 5. Protect airway, tongue, head, never leave patient alone 5. Protect airway, tongue, head, never leave patient alone 6. Intubate all patients if first line drugs fail. 6. Intubate all patients if first line drugs fail.

4 Non-specific  Correct electrolyte imbalance - acidosis lowers seizure threshold, treat with bicarbonate if pH<7.1  Lower fever  Antibiotics/ LP if indicated  If neurologic exam dictates, treatment of underlying cause may proceed concurrently with drug therapy, e.g., neurosurgical decompression.  Hypotension – maintain BP Status Epilepticus - Definite Treatment

5 Status Epilepticus-Definitive Treatment a. Diazepam - 10mg IV push over seconds repeat after 10-15mins upto 30mg (5mg/min) Repeat after 2-4hrs. 100mg/day i.Good results, easy to administer. (fast acting, short lasting) i.Good results, easy to administer. (fast acting, short lasting) ii. If two doses fail to stop status, then further doses probably won't work either. ii. If two doses fail to stop status, then further doses probably won't work either. iii. Side effects -- hypotension, bradycardia, respiratory depression, cardiac arrest, depresses mental status. iii. Side effects -- hypotension, bradycardia, respiratory depression, cardiac arrest, depresses mental status.

6 OR Lorazepam - 4 mg IV push (2mg/min) may be repeated. i. Fast acting, medium lasting. ii. Respiratory depression only in the extubated patient.

7 Status Epilepticus-Definite Treatment b. Phenytoin mg/kg IV (slow IV push) (50mg/min) fast and long acting. b. Phenytoin mg/kg IV (slow IV push) (50mg/min) fast and long acting. i. Presently used concomitantly with a benzodiazepine ii. Its pH is 12, all i.v. fluids are pH 4-6. Do not add to dextrose drip as it preciptiates. ii. Its pH is 12, all i.v. fluids are pH 4-6. Do not add to dextrose drip as it preciptiates. iii. Monitor BP and ECG

8 d.IV Valproate - 25 mg/kg IV push, may repeat. i. Generally not used because of lack of experience. Good results in both major motor and absence status. ii. fast acting, long acting. iii. Far less side effects than Diazepam and dilantin especially in unstable cardiac status, hypotension, hepatic failure etc.

9 Other drugs that can be used: Other drugs that can be used: IV Midazolam, IM fosphenytoin IV Midazolam, IM fosphenytoin IM paraldehyde IM paraldehyde In children and when venous access unavailable, rectal diazepam, lorazepam, midazolam or paraldehyde. In children and when venous access unavailable, rectal diazepam, lorazepam, midazolam or paraldehyde. IV thiopentone, IV lignocaine, IV propofol. IV thiopentone, IV lignocaine, IV propofol. Neuro muscular blocking agents Neuro muscular blocking agents Status Epilepticus - Definite Treatment


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