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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.
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Treatment
One must first be sure that the attacks are continuing before starting
treatment.
Convulsive tonic, clonic or complex partial
status
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Airway, O2, BP and vitals and labs.
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50ml 50% glucose and thiamine 100mg IV.
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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.
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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
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Diazepam and phenytoin and phenobarbital
but do not induce coma.
Petit mal status
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Diazepam as above followed by ethosuximide,
valproic acid or both.
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