A presentation that'll help the healthcare develop clinical skills that'll enable them to quickly identify and effectively manage Status Epilepticus

1. PAEDIATRICS AND CHILD HEALTH
• Paediatrics and Child Health
• Status Epilepticus
Dr. Chongo Shapi (BSc.HB, MBChB)
- Medical Doctor at MOH
-
3/29/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 1

2. Status Epilepticus
• Is a medical emergency
• Definition:
1. Continuous seizures (convulsions) for ≥ 5 min
2. ≥ 2 serial seizures (convulsions) without
recovery of consciousness between them for ≥ 5
min
- Old literature duration: ≥ 30 min
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3. Classification of Status Epilepticus
• Nelson’s Textbook of Paediatrics, 18th Edition:
1. Generalized:
a. Tonic-clonic (more common)
b. Absence
2. Partial
a. Simple
b. Complex
c. With secondary generalization
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4. Status Epilepticus
• Has mortality of 10-15%
• The longer the duration, the greater the risk of
permanent cerebral damage
• Rhambdomyolysis may lead to acute kidney
injury (AKI) in convulsive status epilepticus
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5. Status Epilepticus in Children
• 3 major subtypes:
1. Prolonged febrile seizures for ≥ 30 min
2. Idiopathic status epilepticus: seizure develops
in the absence of an underlying CNS lesion or
insult
3. Symptomatic status epilepticus: seizure occurs
as a result of an underlying neurologic disorder
or a metabolic abnormality
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6. Treatment
1. Is a medical emergency (stabilise and then investigate)
2. Admit to PICU
3. Call for help
4. Check ABCs
5. Suction secretions and give O2 by mask, Ambu bag, ETT
/assisted ventilation. Monitor ABGs and SaO2 by pulse
oximeter
6. Secure IV lines, NGT and urinary catheter
7. Check RBS, and if hypoglycaemic give 5mL/Kg bolus of 10%
dextrose
8. Give anticonvulsant to abort the seizures. Give Lorazepam
IV 4mg bolus. Repeat if necessary. Diazepam or buccal
midazolam is an alternative
9. Monitor vitals (PR, BP, RR, T and urine output)
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7. Established status
- Phenytoin: 15 mg/kg IV diluted in 10mg/ml in
NS into a large vein at 50mg/min (ECG
monitoring required)
- Fosphenytoin can be used as it is a prodrug of
phenytoin
- If on-going seizures:
a. Phenobarbital 10 mg/kg IV diluted 1 in 10 in
water for injection at < 100 mg/min
b. Sodium valproate IV 25mg/kg is an alternative
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8. Refractory status - General anaesthesia
- Only in intensive care setting, intubation and
ventilation usually required
- Propofol bolus 2 mg/kg, repeat, followed by
continuous infusion of 5-10 mg/kg/hr
- Thiopentone and midazolam infusions may also be
used
- Continuous EEG monitoring
- Reinstate previous anti-epileticus drugs (AEDs)
medication via NG tube
- Establish diagnosis: CT or MRI may reveal an
underlying cause
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9. Summary of order of drugs in SE
1. Benzodiazepines: Lorazepam (alternative =
diazepam, midazolam)
2. Phenytoin (alterative = Fosphenytoin)
3. Phenobarbital (alternative = sodium valproate)
4. General anaesthesia:
- Propofol
- Thiopentone
- Midazolam
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10. Treatment
9. Investigate:
a. FBC/DC
b. U/Es + Creatinine
c. Blood/urine for metabolic studies and toxicology
d. LP
e. CT/MRI
f. Continuous EEG if:
- Seizures are refractory to the front-line
anticonvulsants
- Patient is paralyzed and is on a respirator to assess
the frequency of seizure discharges, their location,
and the response to anticonvulsant therapy
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11. Treatment
10. Do a physical and neurologic examination to assess
for:
- Evidence of trauma
- Papilledema
- A bulging anterior fontanel
- Lateralizing neurologic signs suggesting ICP
- Manifestations of sepsis or meningitis
- Retinal hemorrhages that may indicate a subdural
hematoma
- Kussmaul breathing and dehydration suggestive of
metabolic acidosis or irregular respirations signifying
brainstem dysfunction
- Constriction or dilatation of pupils suggesting a toxin
or drugs as the cause of the status epilepticus
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12. Thanks
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