Presentation on theme: "Status Epilepticus-Definition"— Presentation transcript:
1Status Epilepticus-Definition 1. Major motor (convulsive) statusThree(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.
2Status epilepticusIt is a medical emergency – requires prompt and aggressive treatmentTherapy should be aimed at:Rapid termination of status epilepticusPrevention of seizure recurrenceTreatment of underlying cause
3Status Epilepticus - Treatment Immediate treatment1. Secure IV line draw blood for analysis (including anticonvulsant levels).2. Push 50 cc of 50% Dextrose i.v.,100mg thiamine i.v.3. Monitor vital signs.4. Examine patient.5. Protect airway, tongue, head, never leave patient alone6. Intubate all patients if first line drugs fail.
4Status Epilepticus - Definite Treatment Non-specificCorrect electrolyte imbalance - acidosis lowers seizure threshold, treat with bicarbonate if pH<7.1Lower feverAntibiotics/ LP if indicatedIf neurologic exam dictates, treatment of underlying cause may proceed concurrently with drug therapy, e.g., neurosurgical decompression.Hypotension – maintain BP
5Status Epilepticus-Definitive Treatment Diazepam - 10mg IV push over seconds repeat after 10-15mins upto 30mg (5mg/min) Repeat after 2-4hrs. 100mg/dayi.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.iii. Side effects -- hypotension, bradycardia, respiratory depression, cardiac arrest, depresses mental status.
6ORLorazepam - 4 mg IV push (2mg/min) may be repeated.i. Fast acting, medium lasting.ii. Respiratory depression only in the extubated patient.
7Status Epilepticus-Definite Treatment b. Phenytoin mg/kg IV (slow IV push) (50mg/min) fast and long acting.i. Presently used concomitantly with a benzodiazepineii. 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
8IV 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.
9Status Epilepticus - Definite Treatment Other drugs that can be used:IV Midazolam, IM fosphenytoinIM paraldehydeIn children and when venous access unavailable, rectal diazepam, lorazepam, midazolam or paraldehyde.IV thiopentone, IV lignocaine, IV propofol.Neuro muscular blocking agents