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Status epilepticus

Definition

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.

Treatment

One must first be sure that the attacks are continuing before starting treatment.

Convulsive tonic, clonic or complex partial status

  1. Airway, O2, BP and vitals and labs.

  2. 50ml 50% glucose and thiamine 100mg IV.

  3. Diazepam 5mg IV this can be repeated every 1-2 mint until seizures stop or a total of 20mg. Monitor and assist respiration if necessary.

  4. 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).

  5. If persistant then start anaesthesia with phenobarbital, intubation, if seizures persist then neuromuscular blockade. Continuous ECG.

Serial tonic-clonic or partial motor status

  1. Diazepam and phenytoin and phenobarbital but do not induce coma.

Petit mal status

  1. Diazepam as above followed by ethosuximide, valproic acid or both.

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