2. seizure is a paroxysmal event due to
abnormal excessive or synchronous
neuronal activity in the brain
Epilepsy describes a condition in which a
person has recurrent seizures due to a
chronic, underlying process
two or more unprovoked seizures
3. STATUS EPILEPTICUS
Traditional Definition
Continuous seizures or repetitive, discrete seizures
with impaired consciousness in the inter-ictal
period.
Duration of seizure activity should be 15-30 min.
4. SUBTYPES
Convulsive Status Epilepticus
simple partial motor status epilepticus
complex partial status epilepticus with
clonic motor manifestations
generalized myoclonic, generalized tonic,
generalized clonic, and generalized tonic-
clonic
6. ?? 30-minute duration - may delay
aggressive therapy
Irreversible neuronal injury may start after
20 to 30 minutes of GCSE
7. Practical Definition
duration of seizures prompts the acute use
of anticonvulsant therapy
vigorous therapy for status epilepticus be
initiated after 5 minutes of GTCS & complex
partial seizures that last longer than 10
minutes
8. GCSE is an emergency and
must be treated immediately
cardiorespiratory dysfunction,
Hyperthermia
metabolic derangements
irreversible neuronal injury
9. Etiology
most common cause - anticonvulsant
withdrawal or noncompliance
acute cerebrovascular accidents
Metabolic
CNS infection
Alcohol/Drug toxicity
Hypoxia
12. Oxygen, oral airway. Avoid hypoxia!
Consider bag-valve mask ventilation.
Consider intubation
IV/IO access. Treat hypotension, but NOT
hypertension
A
B
C
Common Sense:0-5 minutes
Stabilize the patient-
13. 0-5 minutes….
Give glucose (100 ml D25%), unless
normo- or hyperglycemic
Hyperglycemia has no negative effect in
SE
(as long as significant hyperosmolality is
being avoided)
Thiamin 100 mg IV - if given D25 or if
cachectic/malnourished/alcoholic
14. Initial investigations(0-5 minutes)
….
Labs
Na,K, Ca, Mg, PO4 , BUN, Cret, glucose
CBC
Liver function tests, ammonia
Anticonvulsant level
Toxicology
Blood C/S
Initial screening history and Physical examination
17. Anticonvulsants - Rapid
acting
Benzodiazepines
Lorazepam 0.1- 0.15 mg/kg i.v upto 4-6
mg over 1-2 minutes
If SE persists, repeat every 5-10 minutes
18. If lorazepam is successful in stopping
GCSE, the decision to add another agent
depends on the underlying etiology.
Lorazepam’s durationof action is
approximately 12 to 24 hours.
If the etiologyis reversible (e.g., status
epilepticus due to metabolic or toxic
factors), lorazepam may be the only
treatment necessary.
Another longer-acting AED is needed if
the underlying etiology is not rapidly
reversible
19. Seizures continuing / Stage of
Established Seizure 15 – 35 min
In patients taking Valproate
25mg/kg iv in patients normally taking
valproate and who may be sub
therapeutic
20. Continued…
Seizures continuing / Stage of Established
Seizure 15 – 35 min
Phenytoin:- 20mg/kg Bolus dose IV at the
rate of 50mg/min.
Fosphenytoin:- 20mg PE/kg Bolus dose IV
at the rate of 150mg/min
(Repeat dose of 10mg/kg can be given)
Valproate:-25 mg/kg IV
21. Phenytoin
15-20 mg/kg i.v.
@50mg/min
pH 12
Extravasation causes
severe tissue injury
Onset 10-30 min
May cause
hypotension,
dysrhythmia
Cheap
Fosphenytoin
20 mg PE/kg i.v @
150mg/min
Fosphenytoin 150 mg
is equal to 100 mg
phenytoin
pH 8.6
Extravasation well
tolerated
Onset 5-10 min
May cause
hypotension
Expensive
22. Seizures continuing / Stage of Refractory Status
-general anesthesia should be induced
Propofol:- 2mg/kg IV bolus,Repeat if necessary, followed
by infusion (2 – 10 mg/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:- 0.3mg/kg IV bolus dose at the rate of
4mg/min, rpt every 5 min 3 doses followed by infusion(2
ug/kg/hr)
If seizures have been controlled for 12hrs., reduce
the dose over further 12hrs.
If seizure recurs again GA agent should be given
