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Title: Status epilepticus
Description: Complete note on Status epilepticus suitable for MBBS level. This includes all diagnosis and management guidelines as well.
Description: Complete note on Status epilepticus suitable for MBBS level. This includes all diagnosis and management guidelines as well.
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Status epilepticus
Status epilepticus
• ‘normal’ epileptic seizures last < 2 mins
• SE - sustained seizure activity for > 30 mins
• low probability a seizure > 5 mins will stop
DD
• True SE– continuous fits without recovery
• Serial seizures – frequent with recovery
between fits
• Pseudo status epilepticus (psychogenic
seizures)
Aetiology of status epilepticus
• Electrolyte imbalance
• Cerebrovascular accident / trauma/ hypoxic
insult
• Cerebral SOL
• Drug toxicity
• Encephalitis
• Pre-existing epilepsy
• Chronic alcoholism
Management
• Prompt treatment essential
...
• lorazepam IV
• midazolam for IM
• diazepam for rectal administration
lorazepam
• clinical advantage of lorazepam over diazepam is
duration of action
• as long as 4-6hours because of its less
pronounced redistribution into adipose tissue
• the duration of diazepam's acute anticonvulsant
effect is typically <20 minutes because of
subsequent redistribution of the drug into
adipose tissue
• effect upon seizure activity can be seen as early
as 10 to 20 seconds after administration
Midazolam
• Like lorazepam and diazepam, midazolam is very
effective in terminating seizures rapidly
(frequently in less than one minute),
• Intramuscular, nasal, and buccal administration
of midazolam may be useful in rapidly
terminating seizures when IV access is difficult
• It is particularly helpful in the pre-hospital
treatment of status epilepticus in patients
without IV access and in the management of
refractory status epilepticus
second stage
• intravenous valproate, levetiracetam
• older agents fosphenytoin, phenytoin, and
phenobarbital
third stage
• In the (refractory status epilepticus),
midazolam, thiopentone, and propofol are
available choices
Summary
• status epilepticus high chance of requiring ICU
• If no response to lorazepam very likely to
require general anaesthesia
• thiopental, propofol or midazolam
Title: Status epilepticus
Description: Complete note on Status epilepticus suitable for MBBS level. This includes all diagnosis and management guidelines as well.
Description: Complete note on Status epilepticus suitable for MBBS level. This includes all diagnosis and management guidelines as well.