Status epilepticus ninad
Upcoming SlideShare
Loading in...5
×
 

Like this? Share it with your network

Share

Status epilepticus ninad

on

  • 1,943 views

 

Statistics

Views

Total Views
1,943
Views on SlideShare
1,943
Embed Views
0

Actions

Likes
0
Downloads
121
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Status epilepticus ninad Presentation Transcript

  • 1. STATUS EPILEPTICUS Department of Neurology Yashoda Hospital, Secunderabad.
  • 2. STATUS EPILEPTICUS
    • Definition
      • Continuous seizures or repetitive, discrete seizures with impaired consciousness in the inter-ictal period. Duration of seizure activity should be 15-30 min. OR
      • Single seizure lasting for >10min. OR
      • More than 3 seizures within 30 min.
  • 3. Etiology
    • Drug change/noncompliance
    • Stroke
    • CNS infection
    • Alcohol
    • Hypoxia
  • 4. Continued…
    • Metabolic
    • Intra-cranial space occupying lesion
    • Trauma
    • Fever/infection
    • Congenital
  • 5. Classification
    • Convulsive status
      • Primary generalized
      • Secondary generalized
    • Non convulsive status
    • Epilepsia Partialis Continua
    • Myoclonic Status Epilepticus
  • 6. CONVULSIVE STATUS EPILEPTICUS
    • Generalised tonic clonic convulsion
    • Consequences
    • -Early: - Because of release of
    • Catechloamines
    • -Late: - Failure of Cerebral and systemic
    • protective measures
  • 7. Early Consequences
    • Heart rate & Blood pressure
    • Blood Glucose
    • Cardiac Arrhythmias
    • Gradual rise in Temperature (Prolonged Hyperthermia)
    • Acidosis ( Lactic acid production)
  • 8. Late Consequences
    • Fall in BP
    • Loss of cerebral auto-regulation
    • Hypoglycemia due to exhaustion of glycogen stores & Neurogenic insulin secretion
    • Cerebral Oedema
    • Rhabdomyolysis leading to ATN, Hyperkalemia and hyponatraemia
    • Rarely DIC
  • 9. Management
    • First stage (0-10min)
    • Oxygen and Cardio respiratory Resuscitation
    • -Cardio respiratory assessment
    • - Secure airway
    • -Resuscitate if require
    • -Oxygen should always be administered
  • 10. Second Stage(1-60min)
    • Monitoring
    • - Regular Neurological Observation
    • -Pulse, BP, ECG
    • IV lines
    • -Normal saline
    • -separate lines for different drugs.
    • -Drugs should not be mixed
    • Emergency Anti-convulsant Therapy
  • 11. Continued…
    • Emergency Investigations-
    • -Sugar,ABG Renal and liver Function Test
    • -Calcium, Magnesium Level, CBP
    • -Anticonvulsant level
    • IV glucose & thiamine
    • -50ml of 50% dextrose should be given I.V. if hypoglycemia is suspected.
    • -If there is h/o alcoholism 250mg of Thiamine should be given I.V.
  • 12. Third Stage(0-60/90min)
    • Establish etiology: -
    • -Age, History
    • -Investigations
    • -CT/MRI Brain, CSF examination
    • Medical complications - Hypoxia, Hypo- & Hyper-tension, Cardiac arrhythmias, Cardiac failure, lactic acidosis, Hyperpyrexia, Hypoglycemia , Electrolyte disturbance, raised ICP, organ failure, Rhabdomyolysis, DIC
  • 13. Fourth Stage
    • ICU monitoring
    • -ECG, Pulseoxymetry
    • Seizure and EEG monitoring
    • -Prolonged Status Epilepticus
    • -Comatose Ventilated Patients
    • Initiate long term anticonvulsant therapy
    • -Start long Term AEP
  • 14. Anti-convulsant drug Therapy
    • Stage of Early Status
    • -Lorazepam: -4 mg IV Bolus (0.07mg/kg)
    • Can be repeat after 10 min.
    • -Midazolam: -0.1 – 0.3 mg/kg IV bolus –at 4 mg/min
    • Adverse effects :
            • respiratory depression
            • Hypotension
  • 15. Continued…
    • Seizures continuing / Stage of Established Seizure
    • Phenytoin :- 15-20mg/kg Bolus dose IV at the
    • rate of 50mg/min .
    • Fosphenytoin :- 15-20mg PE/kg Bolus dose IV
    • at the rate of 150mg/min
    • (Repeat dose of 5-10mg/kg can be given)
    • Phenobarbital :-10mg/kg Bolus IV at the rate of
    • 100mg/min.
  • 16.
    • Seizures continuing / Stage of Refractory Status
    • - general anesthesia should be induced
    • Propofol :- 2mg/kg IV bolus,Repeat if necessary, followed by infusion (5mg/kg/hr)
    • Thiopental :- 100-250mg IV bolus over 20 sec. with further 50mg bolus every 2-3 min.until seizure control followed by IV infusion(3-5mg/kg/hr)
    • Midazolam :- 0.1-0.3mg/kg IV bolus dose at the rate of 4mg/min followed by infusion(0.05-0.4mg/kg/hr)
    • If seizures have been controlled for 12hrs., reduce the dose over further 12hrs.
    • If seizure recurs again GA agent should be given
  • 17. Non-Convulsive Status Epilepticus
    • Continuous Neuronal Discharge but no Convulsions
    • Diagnosis dependant on EEG
    • Presentation:-known epilepsy patient
    • -Prolonged change in personality
    • -Prolonged Post ictal stage ( >30min)
    • -Recent onset of Psychosis
  • 18. Treatment IV Phenytoin (fosphenytoin)or phenobarbital Non-convulsive status epilepticus in coma Oral valproate Atypical absence status epilepticus Oral clobazam Complex partial status epilepticus IV or oral benzodiazepines Typical absence status epilepticus Treatment Type
  • 19. Epilepsia Partialis Continua
    • Regular or irregular clonic muscular twitching, affecting limited part of body, occuring for minimum of 1hr, at interval of not more than 10s
    • Causes :- Stroke, Trauma, cerebral inf./abscess, hyperglycemia, hyponatraemia
    • EEG :-Focal abnormality / may be Normal
    • Treatment :- Treat underlying cause.Antiepileptic drug can be considered to prevent complex partial or secondary generalize seizures.
  • 20. Myoclonic Status Epilepticus in coma
    • Well recognized complication of cardiorespiratory arrest (Hypoxia)
    • Characterized by spontaneous and stimulus sensitive myoclonus occurs within 24hrs of coma.
    • Treatment:-Clonazepam, valproate, piracetam
    • Prognosis:- Usually Poor
  • 21. STATUS EPILEPTICUS -action plan
    • Drugs-
    • Initiate with lorazepam or midazolam
    • Maintain with phenytoin / fosphenytoin
    • If status persists- phenobarbital
    • If status persists- pentobarbital or propofol,thiopental anaesthesia with ventilatory support
  • 22. Other drugs in Status epilepticus
    • Valproate
    • IV bolus 15-30 mg/kg
    • Magsulf
    • Indication – Refractory status
    • Dose:-4 gm IV bolus followed by 5 gm deep IM on both sides. rpt. 4hrly
    • Clonazapeam
    • Indication – Early status (Alternative to lorazepam)
    • Dose 1-2 mg bolus over 30 sec.
  • 23. Thank you