It is a condition in which seizures follow one another so rapidly that
new attacks begin before the previous one has ended. If the attacks follow
a close succession this is called serial seizures. Either condition can
occur with partial or generalized epilepsy. It is a very dangerous
condition as permanent brain damage can occur.
There is continuous seizure activity with no recovery between
successive tonic-clonic seizures. This is a life threatening condition
and emergency medical assistance should be called immediately if this is
suspected. A tonic-clonic seizure lasting longer than 5 minutes (or two
minutes longer than the usual seizures for a given epileptic) is usually
considered grounds for calling the emergency services.
One must first be sure that the attacks are continuing before starting
Convulsive tonic, clonic or complex partial
Airway, O2, BP and vitals and labs.
50ml 50% glucose and thiamine 100mg IV.
Diazepam 5mg IV this can be repeated every
1-2 mint until seizures stop or a total of 20mg. Monitor and assist respiration
Phenytoin is given 50mg/mint until seizures
stop or a total of 18mg/kg. It does not cause respiratory depression but
monitor for arrhythmias. Otherwise give phenobarbitone (Luminal).
- If persistant then start anaesthesia with phenobarbital, intubation,
if seizures persist then neuromuscular blockade. Continuous ECG.
Serial tonic-clonic or partial motor status
Diazepam and phenytoin and phenobarbital
but do not induce coma.
Petit mal status
Diazepam as above followed by ethosuximide,
valproic acid or both.