Status epilepticus

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Status epilepticus

  1. 1. STATUS EPILEPTICUS (SE) Status epilepticus is defined as continuous convulsion lasting for more than 30 minute or serial convulsion between which there is no regain of conciousness.
  2. 2. TYPES : 1. Convulsive. 2. Non convulsive. • Convulsive SE is more important because it is associated with increased risk of morbidity & mortality. • MORTALITY RATE : 3—10%. • Majority of death occurs due to underlying brain disease.
  3. 3. ETIOLOGY : • 25 % Prolonged febrile convulsion. • 25% Idiopathic SE with no CNS abnormality. • 25% Symptomatic SE with CNS abnormality or metabolic disorder. • 25% : Meningitis, Encephalitis. - Head trauma , Drug intoxication. - Sub arachnoid hemorrhage. - Pyridoxine dependency.
  4. 4. PREDISPOSING FACTOR : • Sleep deprivation. • Intercurrent infection. • Watching TV, Vedio game , Music for prolonged period. • Alcohol, AED Withdrawl.
  5. 5. MANAGEMENT : • GOALS OF MANAGEMENT : 1. Stabilization of patient. 2. To stop clinical and electrical seizure activity. 3. Prevent recurrence of seizure. 4. Identification and T/t of etiology.
  6. 6. Admit the baby in ICU. STABILIZATION OF PATIENT : Maintenance of ABC . • A – Clear AIRWAY –suction & position. • B – support BREATHING .—O2 inh., Bag & mask ventilation. • C –Circulation.—maintenance of BP. • Moniter –temp, HR, RR, BP & Pulse oxymetry. • All the drugs should be given Intravenously.
  7. 7. STEPS OF DRUG ADMINISTRATION 1. Diazepam 0.2—0.3mg/kg or Lorazepam 0.1 mg/kg— Wait10min . If seizure stops, — No T/t. 2. If seizure continues at 10 min—repeat Diazepam/ Lorazepam 3. If still convulsion after 10 min. , start phenytoin 20mg/kg. (@ 1mg/kg/min.) or phenobarbitone –20mg/kg over 20 min. 4. If convulsion continues— Midazolam 2mg/kg stat then 1—10 microgram/kg/ min IV drip. 5. No control – Thiopental / IV paraldehyde/ General Anasthesia .
  8. 8. If hypoglycemia detected – give 4ml/kg of D25. If delay in IV access : • 0.5 mg/kg of Diazepam or 0.3ml/kg paraldehyde ( 1:1 diluted with oil in glass syringe ) can be given Rectally. • During administration of AED— HR, RR ,BP, cardiac monitor . • Multiple medication with repeated doses may cause Respiratory distress and may require Ventilator .
  9. 9. INVESTIGATION : • CBC , ABG , Serum electrolytes , AED level , Blood sugar. • Urine , Blood & Gastric aspirate for toxicological screening. • Lumbar puncture is deffered till the vitals stable. • CT scanning may be done later .
  10. 10. INVESTIGATION : • CBC , ABG , Serum electrolytes , AED level , Blood sugar. • Urine , Blood & Gastric aspirate for toxicological screening. • Lumbar puncture is deffered till the vitals stable. • CT scanning may be done later .

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