The document summarizes guidelines for the management of status epilepticus from the American Epilepsy Society. It defines status epilepticus and provides timelines. Common causes are listed. Five key questions are addressed through evidence-based conclusions about effective anticonvulsants for initial and subsequent treatment, associated adverse events, the most effective benzodiazepines, efficacy of fosphenytoin vs phenytoin, and when efficacy drops significantly. Recommendations are made for first-line treatments including benzodiazepines, second-line treatments, and refractory status epilepticus treatments.
Status epilepticus is a medical emergency that requires prompt treatment to prevent neurological damage or death. It is defined as continuous seizure activity lasting more than five minutes or two or more discrete seizures between which there is incomplete recovery of consciousness. The document discusses the definition, causes, pathophysiology, treatment approach, and medications used to treat status epilepticus in children. Treatment involves stabilizing the patient, administering rapid-acting anticonvulsants like lorazepam followed by long-acting medications like fosphenytoin if seizures persist, with progression to anesthetic treatments in refractory cases to stop seizures.
- Generalized tonic-clonic status epilepticus (GCSE) is a condition that will likely not terminate rapidly or spontaneously and requires prompt medical intervention. It is defined as continuous seizure activity lasting more than 5 minutes in children over 5 years old.
- Prolonged GCSE can cause respiratory, hemodynamic, metabolic, and other systemic complications that increase the risk of mortality and neurological injury if not treated promptly. Initial treatment involves rapid-acting benzodiazepines followed by longer-acting anticonvulsants like phenytoin or phenobarbital.
Status epilepticus is defined as continuous seizures or repetitive seizures without full recovery of consciousness between seizures. It can be convulsive, involving motor symptoms, or nonconvulsive without motor symptoms. The traditional definition is seizures lasting 15-30 minutes but immediate treatment is recommended after 5 minutes for generalized tonic-clonic seizures or 10 minutes for complex partial seizures. Initial treatment involves stabilizing the patient and administering lorazepam. If seizures continue, phenytoin, fosphenytoin, or valproate is given. For refractory status epilepticus, general anesthesia with propofol, thiopental, or midazolam is induced. The longer status epilepticus continues, the higher
1. Convulsive status epilepticus has a bimodal distribution, peaking in children and the elderly, and has multiple potential causes including infections, strokes, alcohol withdrawal and brain injuries.
2. Mortality rates range from 10.5-28% and neurological sequelae occur in 11-16% of patients. Refractory status epilepticus is defined as continuing despite benzodiazepines and other anticonvulsants.
3. Treatment involves terminating seizures acutely with benzodiazepines like lorazepam and diazepam. For refractory cases, second line drugs like phenytoin, fosphenytoin, valproate, levetirac
This document provides guidelines on the management of status epilepticus. It defines status epilepticus and discusses types. It outlines common etiologies and systemic complications. Treatment protocols are discussed including first, second, and third line anticonvulsant medications for both adults and children. Precautions and side effects of different medications are mentioned. The importance of early treatment and monitoring is emphasized to terminate seizures and prevent complications.
Status epilepticus is a medical emergency that requires prompt treatment to reduce mortality and morbidity. It is defined as continuous seizures for more than 5 minutes or two or more seizures without full recovery of consciousness between seizures. The longer seizures continue, the harder they are to stop and the higher the risks of permanent neurological damage and death. Treatment involves stabilizing the patient, administering rapid-acting benzodiazepines like lorazepam followed by long-acting anticonvulsants like fosphenytoin, phenobarbital, or phenytoin. If seizures continue, further doses of anticonvulsants or anesthetic medications may be needed. Prompt diagnosis and treatment are essential to minimize risks
The document provides information about different types of seizures:
1. Status epilepticus is a condition where seizures continue for more than 30 minutes or seizures occur without recovery in between.
2. Several types of seizures are defined, including absence seizures (petit mal), atonic seizures (drop attacks), clonic seizures, myoclonic seizures, tonic seizures, and tonic-clonic seizures (grand mal).
3. Simple partial seizures can affect motor function, senses, autonomic functions, or thinking/emotions, while the person remains conscious. Complex partial seizures involve impaired consciousness in addition to symptoms.
This document provides information on status epilepticus, including its definition, epidemiology, etiology, pathophysiology, treatment, and classification. Key points include:
- Status epilepticus is defined as a seizure lasting over 30 minutes or recurrent seizures without regaining consciousness for over 30 minutes.
- It can be caused by acute brain insults, underlying epilepsy, or unknown etiology. Prolonged seizures can cause neuronal damage.
- Treatment involves maintaining airway, breathing, and circulation. Benzodiazepines like lorazepam or diazepam are first line to stop seizures. Phenytoin, fosphenytoin, phenobarbital, and val
Status epilepticus is a medical emergency that requires prompt treatment to prevent neurological damage or death. It is defined as continuous seizure activity lasting more than five minutes or two or more discrete seizures between which there is incomplete recovery of consciousness. The document discusses the definition, causes, pathophysiology, treatment approach, and medications used to treat status epilepticus in children. Treatment involves stabilizing the patient, administering rapid-acting anticonvulsants like lorazepam followed by long-acting medications like fosphenytoin if seizures persist, with progression to anesthetic treatments in refractory cases to stop seizures.
- Generalized tonic-clonic status epilepticus (GCSE) is a condition that will likely not terminate rapidly or spontaneously and requires prompt medical intervention. It is defined as continuous seizure activity lasting more than 5 minutes in children over 5 years old.
- Prolonged GCSE can cause respiratory, hemodynamic, metabolic, and other systemic complications that increase the risk of mortality and neurological injury if not treated promptly. Initial treatment involves rapid-acting benzodiazepines followed by longer-acting anticonvulsants like phenytoin or phenobarbital.
Status epilepticus is defined as continuous seizures or repetitive seizures without full recovery of consciousness between seizures. It can be convulsive, involving motor symptoms, or nonconvulsive without motor symptoms. The traditional definition is seizures lasting 15-30 minutes but immediate treatment is recommended after 5 minutes for generalized tonic-clonic seizures or 10 minutes for complex partial seizures. Initial treatment involves stabilizing the patient and administering lorazepam. If seizures continue, phenytoin, fosphenytoin, or valproate is given. For refractory status epilepticus, general anesthesia with propofol, thiopental, or midazolam is induced. The longer status epilepticus continues, the higher
1. Convulsive status epilepticus has a bimodal distribution, peaking in children and the elderly, and has multiple potential causes including infections, strokes, alcohol withdrawal and brain injuries.
2. Mortality rates range from 10.5-28% and neurological sequelae occur in 11-16% of patients. Refractory status epilepticus is defined as continuing despite benzodiazepines and other anticonvulsants.
3. Treatment involves terminating seizures acutely with benzodiazepines like lorazepam and diazepam. For refractory cases, second line drugs like phenytoin, fosphenytoin, valproate, levetirac
This document provides guidelines on the management of status epilepticus. It defines status epilepticus and discusses types. It outlines common etiologies and systemic complications. Treatment protocols are discussed including first, second, and third line anticonvulsant medications for both adults and children. Precautions and side effects of different medications are mentioned. The importance of early treatment and monitoring is emphasized to terminate seizures and prevent complications.
Status epilepticus is a medical emergency that requires prompt treatment to reduce mortality and morbidity. It is defined as continuous seizures for more than 5 minutes or two or more seizures without full recovery of consciousness between seizures. The longer seizures continue, the harder they are to stop and the higher the risks of permanent neurological damage and death. Treatment involves stabilizing the patient, administering rapid-acting benzodiazepines like lorazepam followed by long-acting anticonvulsants like fosphenytoin, phenobarbital, or phenytoin. If seizures continue, further doses of anticonvulsants or anesthetic medications may be needed. Prompt diagnosis and treatment are essential to minimize risks
The document provides information about different types of seizures:
1. Status epilepticus is a condition where seizures continue for more than 30 minutes or seizures occur without recovery in between.
2. Several types of seizures are defined, including absence seizures (petit mal), atonic seizures (drop attacks), clonic seizures, myoclonic seizures, tonic seizures, and tonic-clonic seizures (grand mal).
3. Simple partial seizures can affect motor function, senses, autonomic functions, or thinking/emotions, while the person remains conscious. Complex partial seizures involve impaired consciousness in addition to symptoms.
This document provides information on status epilepticus, including its definition, epidemiology, etiology, pathophysiology, treatment, and classification. Key points include:
- Status epilepticus is defined as a seizure lasting over 30 minutes or recurrent seizures without regaining consciousness for over 30 minutes.
- It can be caused by acute brain insults, underlying epilepsy, or unknown etiology. Prolonged seizures can cause neuronal damage.
- Treatment involves maintaining airway, breathing, and circulation. Benzodiazepines like lorazepam or diazepam are first line to stop seizures. Phenytoin, fosphenytoin, phenobarbital, and val
1. Status epilepticus (SE) is a medical emergency defined as a seizure lasting more than 5 minutes or recurrent seizures without regaining consciousness. SE can be convulsive or non-convulsive.
2. The annual incidence of SE is estimated to be between 9,000-14,000 new cases per year in the UK. Mortality is about 20-30% and is higher in the elderly.
3. SE is initially treated with benzodiazepines like lorazepam or diazepam. If seizures continue, second line drugs like fosphenytoin or phenytoin are used. For refractory SE, anesthetic drugs under ICU care may be required
Status epilepticus is defined as continuous seizure activity or intermittent seizures without full recovery between seizures. It can be convulsive or non-convulsive. Initial treatment involves stabilizing the airway, breathing, and circulation, followed by benzodiazepines like lorazepam or diazepam to stop seizures. If seizures continue, second line drugs like fosphenytoin or levetiracetam are used. For refractory cases, continuous infusions of midazolam, pentobarbital or propofol may be needed. The most common adverse effect is respiratory depression, so patients require monitoring. No significant difference in effectiveness exists between lorazepam and diazepam as initial
Status epilepticus is a medical emergency that requires prompt treatment to prevent irreversible brain damage. It is defined as continuous seizure activity lasting more than five minutes, or two or more seizures between which consciousness is not regained. Status epilepticus can be classified as generalized convulsive or non-convulsive and has various etiologies including low anti-epileptic drug levels, stroke, electrolyte imbalances, and infections. Treatment involves airway protection, treatment of underlying causes, administration of benzodiazepines or phenytoin to stop seizures, and induction of anesthesia with thiopental or propofol if seizures persist. Outcomes depend on factors like age, etiology, and degree of impaired consciousness,
This document summarizes guidelines from the American Epilepsy Society and Indian Pediatrics for the treatment of status epilepticus in children and adults. It defines status epilepticus and evaluates questions around effective initial and subsequent anticonvulsant therapies. For initial treatment, lorazepam, diazepam, and midazolam are recommended benzodiazepines, with midazolam preferred without IV access. Phenytoin or fosphenytoin are suggested as second line therapies. The treatment success rates decline with each subsequent therapy, and refractory cases may require anesthetic doses of midazolam, pentobarbital, propofol or thiopental with EEG monitoring. Rectal
1) Status epilepticus refers to prolonged or continuous seizure activity lasting more than 5 minutes. It is a medical emergency that can cause neuronal damage the longer it persists.
2) Treatment involves controlling airway and vital signs, administering glucose and thiamine, performing diagnostic tests, and starting anticonvulsant drug therapy.
3) First line drug therapy includes lorazepam or diazepam followed by phenytoin or fosphenytoin. If seizures continue, additional doses of these drugs or alternative drugs like phenobarbital are given.
Status epilepticus is defined as continuous seizure activity lasting longer than 5 minutes or recurrent seizures without regaining consciousness between seizures for greater than 30 minutes. It requires immediate treatment to prevent neurological damage. Initial treatment involves airway management, IV access, glucose/thiamine administration, and first line anti-seizure medications like lorazepam, midazolam, or diazepam. Second and third line agents are used if seizures continue. Continuous EEG monitoring is important for detecting both overt and subtle seizures. Prompt treatment is crucial as delays can reduce effectiveness.
This document discusses convulsive status epilepticus (CSE). It notes that the worldwide incidence of CSE is highest in children and the elderly, with mortality rates ranging from 10.5-28% and neurological sequelae occurring in 11-16% of patients. The most common causes of CSE are listed as low anti-epileptic drug levels, stroke, alcohol withdrawal, anoxic brain injury, and metabolic disturbances. The document provides details on the definition, types, risk factors, complications, management, and treatment of CSE.
Status epilepticus is defined as continuous seizures lasting more than 30 minutes or recurrent seizures without regaining consciousness between seizures. It requires urgent treatment to prevent neurological complications. The first step is to administer oxygen, stabilize airway and circulation. Lorazepam or midazolam is given as initial treatment, followed by phenytoin/fosphenytoin if seizures continue. For refractory cases, general anesthesia with propofol, thiopental or pentobarbital is needed along with ventilatory support. Long term anticonvulsants are also initiated to control seizures.
Non convulsive status epilepticus clinical features, diagnosisMohammad A.S. Kamil
This document discusses non-convulsive status epilepticus (NCSE), beginning with definitions and classifications. It then provides several case studies demonstrating EEG findings in NCSE patients and how their status epilepticus responded to treatment with benzodiazepines or other anticonvulsants. The document concludes by outlining treatment recommendations for different types of NCSE, including absence status epilepticus, complex partial status epilepticus, atypical absence status epilepticus, and NCSE occurring in coma.
Status epilepticus is a life-threatening condition defined as a seizure lasting more than 5 minutes or recurrent seizures without regaining consciousness. It can be caused by changes in medication, infection, stroke, or other medical conditions. Symptoms include muscle spasms, confusion, and impaired consciousness. Diagnosis involves examination and electroencephalography. Treatment goals are resuscitation, terminating seizures, decreasing cerebral metabolism, and treating underlying causes. First-line treatments are benzodiazepines while refractory cases may require barbiturates, propofol, or midazolam infusion. Prognosis depends on duration and cause, with prolonged seizures carrying higher mortality and worse outcomes.
A 31-year-old male presented with a fever for one week and seizures and altered sensorium for three days. He experienced generalized tonic-clonic seizures that were initially uncontrolled. Imaging showed findings suggestive of viral or autoimmune encephalitis. Refractory status epilepticus was diagnosed and treated with high doses of multiple antiepileptic drugs, including lacosamide, which eventually controlled the seizures. Status epilepticus is defined as a seizure that persists for a sufficient length of time or is repeated frequently enough that recovery between attacks does not occur. The pathophysiology involves reductions in inhibitory GABA receptors and increases in excitatory glutamate receptors over time.
Status epilepticus is a medical emergency defined as continuous seizure activity lasting more than 5 minutes or recurrent seizures without regaining consciousness. It has an incidence rate of 10-60 per 100,000 people and is most common in children under 5 years old. Causes include infections, brain injuries, genetic conditions, and noncompliance with anti-seizure medications. The pathophysiology involves excessive excitation and reduced inhibition in the brain. Treatment involves stabilizing the patient, identifying and treating the underlying cause, giving benzodiazepines and other anti-seizure medications, and controlling refractory cases in the ICU with anesthetic medications. Early intervention is important to prevent neurological damage from prolonged seizures.
The document defines status epilepticus as seizure activity that continues for 30 minutes or more, or recurrent seizures without recovery in between. It can be caused by factors like febrile illness in children, anticonvulsant withdrawal, metabolic disturbances, drugs or alcohol, infections, tumors or head trauma. Treatment involves stabilizing the patient, administering benzodiazepines like lorazepam intravenously to stop seizures, followed by anti-seizure drugs like fosphenytoin or phenobarbital if needed. Complications can include cardiac, respiratory or metabolic issues if not treated promptly.
Recent guidelines for management of status epilepticusAbhignaBabu
This document provides guidelines for the management of status epilepticus (SE), which is defined as continuous seizure activity lasting 5 minutes or more, or recurrent seizures without recovery between seizures. It describes the types of SE, causes, initial steps, and pharmacotherapy management. The principal goals are to stop seizure activity and treat any underlying cause. Initial treatment involves benzodiazepines, followed by anticonvulsants if needed. For refractory SE lasting over 40 minutes, anesthetic doses of medications may be required. The guidelines outline stabilization, initial therapy, second therapy, and third therapy phases for treatment.
Status epilepticus is defined as continuous seizure activity lasting more than 5 minutes or two or more seizures without full recovery between seizures. It is classified into different types and has different clinical stages. Initial treatment involves benzodiazepines like lorazepam, diazepam, or midazolam. For refractory status epilepticus, additional anticonvulsants like fosphenytoin, valproate, or phenobarbital are used. If seizures continue, anesthetic agents like propofol, midazolam, or pentobarbitone are utilized to induce a burst suppression pattern on EEG for 12-24 hours.
This document discusses pediatric status epilepticus. Key points include:
- Status epilepticus is a medical emergency associated with high mortality and morbidity. The goal is to stop seizures as quickly as possible to prevent injury.
- Benzodiazepines are the first-line treatment, with lorazepam administered intravenously if possible. Alternative routes can be used if IV access is delayed.
- Second-line treatments include fosphenytoin, phenytoin or phenobarbital. Fosphenytoin is preferred due to less side effects.
- Refractory status epilepticus may require additional anticonvulsants, sedation, and potentially intubation
Status epilepticus is a life-threatening condition defined as one continuous seizure lasting more than 30 minutes or recurrent seizures without regaining consciousness between seizures for over 30 minutes. It is most common in people with epilepsy due to insufficient medication but can also occur in new epileptics or those with brain disorders, infections, tumors or trauma. Immediate treatment with benzodiazepines like lorazepam is recommended to stop the seizures, with barbiturates, anesthetics or other drugs used if initial treatment fails. Permanent neurological damage can occur if status epilepticus is not terminated rapidly.
This document provides an overview of status epilepticus (SE), including definitions, epidemiology, clinical features, causes, pathophysiology, and management. SE is defined as continuous or rapidly repeating seizures without recovery between seizures. It is a medical emergency associated with significant morbidity and mortality. Initial treatment involves benzodiazepines such as lorazepam or diazepam. If seizures continue, second-line treatments include phenytoin, fosphenytoin, or phenobarbital. For refractory cases, anesthetic doses of midazolam, propofol, or barbiturates may be used. Timely treatment is important to improve outcomes.
Status epilepticus (SE) is a medical emergency defined by continuous seizure activity lasting more than 5 minutes for generalized seizures or more than 10 minutes for focal seizures. The condition requires rapid treatment to prevent neuronal injury and death from prolonged excitatory activity. Management involves initial airway and hemodynamic stabilization, followed by benzodiazepines as first-line treatment. If seizures continue, second-line drugs like phenytoin are used. Refractory SE fails to respond to first- and second-line drugs, while super-refractory SE continues despite anesthesia with midazolam or barbiturates. Early, aggressive treatment is needed to terminate seizures and prevent neurological complications.
This document provides guidelines for the management of status epilepticus. It defines status epilepticus as 5 minutes or more of continuous seizure activity or recurrent seizures without recovery between seizures. Status epilepticus can be classified based on age of onset, etiology, clinical features, and EEG features. Common causes include stroke, low anti-epileptic drug levels, alcohol withdrawal, anoxic brain injury, and metabolic disturbances. Initial management involves stabilization, benzodiazepine administration, and consultation with neurology if seizures continue. For refractory or subtle cases, continuous EEG monitoring, additional anti-epileptic drugs, and anesthetic drugs like midazolam or propofol may be used. Nonpharmacological
Status epilepticus (SE) is defined as a seizure lasting more than 30 minutes or recurrent seizures without regaining consciousness between seizures. SE is a medical emergency that requires rapid treatment to prevent neurological complications. The first line treatment for SE is a benzodiazepine like lorazepam or diazepam administered intravenously. If seizures continue after 10 minutes, a second antiseizure drug such as levetiracetam, fosphenytoin, or valproate is given. For refractory SE that persists despite two medications, a continuous infusion of midazolam, propofol, or pentobarbital is started.
This document discusses pediatric procedural sedation and analgesia (PSA). It defines sedation as a reduction in awareness while analgesia is a reduction in pain perception. PSA involves using sedatives, analgesics, and dissociative agents to relieve anxiety and pain from medical procedures. The targeted depth of sedation and choice of agents depends on factors like the procedure, pain level, and patient characteristics. Common medication categories used include sedatives, analgesics, dissociative medications, inhalation medications, and reversal agents. Adverse events and contraindications are discussed for each category.
1. Status epilepticus (SE) is a medical emergency defined as a seizure lasting more than 5 minutes or recurrent seizures without regaining consciousness. SE can be convulsive or non-convulsive.
2. The annual incidence of SE is estimated to be between 9,000-14,000 new cases per year in the UK. Mortality is about 20-30% and is higher in the elderly.
3. SE is initially treated with benzodiazepines like lorazepam or diazepam. If seizures continue, second line drugs like fosphenytoin or phenytoin are used. For refractory SE, anesthetic drugs under ICU care may be required
Status epilepticus is defined as continuous seizure activity or intermittent seizures without full recovery between seizures. It can be convulsive or non-convulsive. Initial treatment involves stabilizing the airway, breathing, and circulation, followed by benzodiazepines like lorazepam or diazepam to stop seizures. If seizures continue, second line drugs like fosphenytoin or levetiracetam are used. For refractory cases, continuous infusions of midazolam, pentobarbital or propofol may be needed. The most common adverse effect is respiratory depression, so patients require monitoring. No significant difference in effectiveness exists between lorazepam and diazepam as initial
Status epilepticus is a medical emergency that requires prompt treatment to prevent irreversible brain damage. It is defined as continuous seizure activity lasting more than five minutes, or two or more seizures between which consciousness is not regained. Status epilepticus can be classified as generalized convulsive or non-convulsive and has various etiologies including low anti-epileptic drug levels, stroke, electrolyte imbalances, and infections. Treatment involves airway protection, treatment of underlying causes, administration of benzodiazepines or phenytoin to stop seizures, and induction of anesthesia with thiopental or propofol if seizures persist. Outcomes depend on factors like age, etiology, and degree of impaired consciousness,
This document summarizes guidelines from the American Epilepsy Society and Indian Pediatrics for the treatment of status epilepticus in children and adults. It defines status epilepticus and evaluates questions around effective initial and subsequent anticonvulsant therapies. For initial treatment, lorazepam, diazepam, and midazolam are recommended benzodiazepines, with midazolam preferred without IV access. Phenytoin or fosphenytoin are suggested as second line therapies. The treatment success rates decline with each subsequent therapy, and refractory cases may require anesthetic doses of midazolam, pentobarbital, propofol or thiopental with EEG monitoring. Rectal
1) Status epilepticus refers to prolonged or continuous seizure activity lasting more than 5 minutes. It is a medical emergency that can cause neuronal damage the longer it persists.
2) Treatment involves controlling airway and vital signs, administering glucose and thiamine, performing diagnostic tests, and starting anticonvulsant drug therapy.
3) First line drug therapy includes lorazepam or diazepam followed by phenytoin or fosphenytoin. If seizures continue, additional doses of these drugs or alternative drugs like phenobarbital are given.
Status epilepticus is defined as continuous seizure activity lasting longer than 5 minutes or recurrent seizures without regaining consciousness between seizures for greater than 30 minutes. It requires immediate treatment to prevent neurological damage. Initial treatment involves airway management, IV access, glucose/thiamine administration, and first line anti-seizure medications like lorazepam, midazolam, or diazepam. Second and third line agents are used if seizures continue. Continuous EEG monitoring is important for detecting both overt and subtle seizures. Prompt treatment is crucial as delays can reduce effectiveness.
This document discusses convulsive status epilepticus (CSE). It notes that the worldwide incidence of CSE is highest in children and the elderly, with mortality rates ranging from 10.5-28% and neurological sequelae occurring in 11-16% of patients. The most common causes of CSE are listed as low anti-epileptic drug levels, stroke, alcohol withdrawal, anoxic brain injury, and metabolic disturbances. The document provides details on the definition, types, risk factors, complications, management, and treatment of CSE.
Status epilepticus is defined as continuous seizures lasting more than 30 minutes or recurrent seizures without regaining consciousness between seizures. It requires urgent treatment to prevent neurological complications. The first step is to administer oxygen, stabilize airway and circulation. Lorazepam or midazolam is given as initial treatment, followed by phenytoin/fosphenytoin if seizures continue. For refractory cases, general anesthesia with propofol, thiopental or pentobarbital is needed along with ventilatory support. Long term anticonvulsants are also initiated to control seizures.
Non convulsive status epilepticus clinical features, diagnosisMohammad A.S. Kamil
This document discusses non-convulsive status epilepticus (NCSE), beginning with definitions and classifications. It then provides several case studies demonstrating EEG findings in NCSE patients and how their status epilepticus responded to treatment with benzodiazepines or other anticonvulsants. The document concludes by outlining treatment recommendations for different types of NCSE, including absence status epilepticus, complex partial status epilepticus, atypical absence status epilepticus, and NCSE occurring in coma.
Status epilepticus is a life-threatening condition defined as a seizure lasting more than 5 minutes or recurrent seizures without regaining consciousness. It can be caused by changes in medication, infection, stroke, or other medical conditions. Symptoms include muscle spasms, confusion, and impaired consciousness. Diagnosis involves examination and electroencephalography. Treatment goals are resuscitation, terminating seizures, decreasing cerebral metabolism, and treating underlying causes. First-line treatments are benzodiazepines while refractory cases may require barbiturates, propofol, or midazolam infusion. Prognosis depends on duration and cause, with prolonged seizures carrying higher mortality and worse outcomes.
A 31-year-old male presented with a fever for one week and seizures and altered sensorium for three days. He experienced generalized tonic-clonic seizures that were initially uncontrolled. Imaging showed findings suggestive of viral or autoimmune encephalitis. Refractory status epilepticus was diagnosed and treated with high doses of multiple antiepileptic drugs, including lacosamide, which eventually controlled the seizures. Status epilepticus is defined as a seizure that persists for a sufficient length of time or is repeated frequently enough that recovery between attacks does not occur. The pathophysiology involves reductions in inhibitory GABA receptors and increases in excitatory glutamate receptors over time.
Status epilepticus is a medical emergency defined as continuous seizure activity lasting more than 5 minutes or recurrent seizures without regaining consciousness. It has an incidence rate of 10-60 per 100,000 people and is most common in children under 5 years old. Causes include infections, brain injuries, genetic conditions, and noncompliance with anti-seizure medications. The pathophysiology involves excessive excitation and reduced inhibition in the brain. Treatment involves stabilizing the patient, identifying and treating the underlying cause, giving benzodiazepines and other anti-seizure medications, and controlling refractory cases in the ICU with anesthetic medications. Early intervention is important to prevent neurological damage from prolonged seizures.
The document defines status epilepticus as seizure activity that continues for 30 minutes or more, or recurrent seizures without recovery in between. It can be caused by factors like febrile illness in children, anticonvulsant withdrawal, metabolic disturbances, drugs or alcohol, infections, tumors or head trauma. Treatment involves stabilizing the patient, administering benzodiazepines like lorazepam intravenously to stop seizures, followed by anti-seizure drugs like fosphenytoin or phenobarbital if needed. Complications can include cardiac, respiratory or metabolic issues if not treated promptly.
Recent guidelines for management of status epilepticusAbhignaBabu
This document provides guidelines for the management of status epilepticus (SE), which is defined as continuous seizure activity lasting 5 minutes or more, or recurrent seizures without recovery between seizures. It describes the types of SE, causes, initial steps, and pharmacotherapy management. The principal goals are to stop seizure activity and treat any underlying cause. Initial treatment involves benzodiazepines, followed by anticonvulsants if needed. For refractory SE lasting over 40 minutes, anesthetic doses of medications may be required. The guidelines outline stabilization, initial therapy, second therapy, and third therapy phases for treatment.
Status epilepticus is defined as continuous seizure activity lasting more than 5 minutes or two or more seizures without full recovery between seizures. It is classified into different types and has different clinical stages. Initial treatment involves benzodiazepines like lorazepam, diazepam, or midazolam. For refractory status epilepticus, additional anticonvulsants like fosphenytoin, valproate, or phenobarbital are used. If seizures continue, anesthetic agents like propofol, midazolam, or pentobarbitone are utilized to induce a burst suppression pattern on EEG for 12-24 hours.
This document discusses pediatric status epilepticus. Key points include:
- Status epilepticus is a medical emergency associated with high mortality and morbidity. The goal is to stop seizures as quickly as possible to prevent injury.
- Benzodiazepines are the first-line treatment, with lorazepam administered intravenously if possible. Alternative routes can be used if IV access is delayed.
- Second-line treatments include fosphenytoin, phenytoin or phenobarbital. Fosphenytoin is preferred due to less side effects.
- Refractory status epilepticus may require additional anticonvulsants, sedation, and potentially intubation
Status epilepticus is a life-threatening condition defined as one continuous seizure lasting more than 30 minutes or recurrent seizures without regaining consciousness between seizures for over 30 minutes. It is most common in people with epilepsy due to insufficient medication but can also occur in new epileptics or those with brain disorders, infections, tumors or trauma. Immediate treatment with benzodiazepines like lorazepam is recommended to stop the seizures, with barbiturates, anesthetics or other drugs used if initial treatment fails. Permanent neurological damage can occur if status epilepticus is not terminated rapidly.
This document provides an overview of status epilepticus (SE), including definitions, epidemiology, clinical features, causes, pathophysiology, and management. SE is defined as continuous or rapidly repeating seizures without recovery between seizures. It is a medical emergency associated with significant morbidity and mortality. Initial treatment involves benzodiazepines such as lorazepam or diazepam. If seizures continue, second-line treatments include phenytoin, fosphenytoin, or phenobarbital. For refractory cases, anesthetic doses of midazolam, propofol, or barbiturates may be used. Timely treatment is important to improve outcomes.
Status epilepticus (SE) is a medical emergency defined by continuous seizure activity lasting more than 5 minutes for generalized seizures or more than 10 minutes for focal seizures. The condition requires rapid treatment to prevent neuronal injury and death from prolonged excitatory activity. Management involves initial airway and hemodynamic stabilization, followed by benzodiazepines as first-line treatment. If seizures continue, second-line drugs like phenytoin are used. Refractory SE fails to respond to first- and second-line drugs, while super-refractory SE continues despite anesthesia with midazolam or barbiturates. Early, aggressive treatment is needed to terminate seizures and prevent neurological complications.
This document provides guidelines for the management of status epilepticus. It defines status epilepticus as 5 minutes or more of continuous seizure activity or recurrent seizures without recovery between seizures. Status epilepticus can be classified based on age of onset, etiology, clinical features, and EEG features. Common causes include stroke, low anti-epileptic drug levels, alcohol withdrawal, anoxic brain injury, and metabolic disturbances. Initial management involves stabilization, benzodiazepine administration, and consultation with neurology if seizures continue. For refractory or subtle cases, continuous EEG monitoring, additional anti-epileptic drugs, and anesthetic drugs like midazolam or propofol may be used. Nonpharmacological
Status epilepticus (SE) is defined as a seizure lasting more than 30 minutes or recurrent seizures without regaining consciousness between seizures. SE is a medical emergency that requires rapid treatment to prevent neurological complications. The first line treatment for SE is a benzodiazepine like lorazepam or diazepam administered intravenously. If seizures continue after 10 minutes, a second antiseizure drug such as levetiracetam, fosphenytoin, or valproate is given. For refractory SE that persists despite two medications, a continuous infusion of midazolam, propofol, or pentobarbital is started.
This document discusses pediatric procedural sedation and analgesia (PSA). It defines sedation as a reduction in awareness while analgesia is a reduction in pain perception. PSA involves using sedatives, analgesics, and dissociative agents to relieve anxiety and pain from medical procedures. The targeted depth of sedation and choice of agents depends on factors like the procedure, pain level, and patient characteristics. Common medication categories used include sedatives, analgesics, dissociative medications, inhalation medications, and reversal agents. Adverse events and contraindications are discussed for each category.
The document discusses requirements and techniques for general anesthesia in ambulatory or day surgery settings. It emphasizes the need for rapid induction and recovery from anesthesia with minimal side effects so patients can return home safely after surgery. It discusses factors to consider when choosing an anesthetic technique, as well as essential intraoperative monitoring guidelines. Both inhalational and total intravenous anesthesia techniques are evaluated in terms of their advantages and disadvantages for day surgery.
This document discusses anesthesia considerations for in vitro fertilization (IVF). It outlines the IVF process and notes that oocyte retrieval is a stressful, painful component. The role of the anesthesiologist is to provide pain relief, proper medical history evaluation, and counseling to reduce patient anxiety. Various anesthesia techniques are described, including monitored anesthesia care, general anesthesia, regional techniques, and total intravenous anesthesia. Factors like medication interactions, obesity, and medical comorbidities require special consideration. The goal of anesthesia is to provide adequate pain relief while using agents and techniques that minimize potential negative effects on fertility and pregnancy outcomes.
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Status epilepticus : TIME FOR NEW GUIDLINES
1. STATUS EPILEPTICUS
Time for a New Guideline for
Management
Prof Ashraf Abdou
NEUROPSYCHIATRY DEPARTMENT
FACULTY OF MEDICINE
ALEXANDRIA UNIVERSITY
Member AAN - SfN
2. Definition
Conventional “textbook” definition of status epilepticus:
Single seizure > 30 minutes
Series of seizures > 30 minutes without full recovery
Why 30 min?
Animal experiments in the 1970s and 1980s had shown that ...
… neuronal injury could be demonstrated after 30 min of seizure activity, even while
maintaining respiration and circulation.
Operational definition
Generalized, convulsive status epilepticus in children and
adults refers to > 5 minutes of continuous seizure or >2
discrete seizures with incomplete recovery of consciousness
Patients with generalized seizure activity at arrival in the ER are treated promptly regardless of prior
duration
7. Starting in 2012 supported by American Epilepsy Society
The goal of this current guideline is to provide evidence-based
answers to efficacy, safety, and tolerability questions regarding the
treatment of convulsive status epilepticus and to synthesize these
answers into a treatment algorithm
9. QUESTION TO BE ANSWERED
Q1. Which Anticonvulsants Are Efficacious as Initial and Subsequent
Therapy?
Q2. What Adverse Events Are Associated With Anticonvulsant
Administration?
Q3. Which Is the Most Effective Benzodiazepine?
Q4. Is IV Fosphenytoin More Effective Than IV Phenytoin?
Q5. When Does Anticonvulsant Efficacy Drop Significantly (i.e., After How
Many Different Anticonvulsants Does Status Epilepticus Become Refractory)?
10. Q1. Which Anticonvulsants Are Efficacious as Initial and Subsequent
Therapy?
The following conclusions were drawn. In ADULTS,
IM midazolam, IV lorazepam, IV diazepam (with or without
phenytoin), and IV phenobarbital are established as efficacious at
stopping seizures lasting at least 5 minutes (level A).
Intramuscular midazolam has superior effectiveness compared
with IV lorazepam in adults with convulsive status epilepticus
without established IV access (level A).
Intravenous lorazepam is more effective than IV phenytoin in
stopping seizures lasting at least 10 minutes (level A).
11. Q1. Which Anticonvulsants Are Efficacious as Initial and
Subsequent Therapy?
The following conclusions were drawn. In ADULTS,
There is no difference in efficacy between IV lorazepam followed by IV
phenytoin, IV diazepam plus phenytoin followed by IV lorazepam, and
IV phenobarbital followed by IV phenytoin (level A).
Intravenous valproic acid has similar efficacy to IV phenytoin or
continuous IV diazepam as second therapy after failure of a
benzodiazepine (level C).
Insufficient data exist in adults about the efficacy of Levetiracetam as
either initial or second therapy (level U).
12. Q1. Which Anticonvulsants Are Efficacious as
Initial and Subsequent Therapy?
The following conclusions were drawn. In PEDIATRICS
IV lorazepam and IV diazepam are established as efficacious at
stopping seizures lasting at least 5 minutes (level A).
Rectal diazepam, IM midazolam, intranasal midazolam, and buccal
midazolam are probably effective at stopping seizures lasting at least
5 minutes (level B).
Insufficient data exist in children about the efficacy of intranasal
lorazepam, sublingual lorazepam, rectal lorazepam, valproic acid,
Levetiracetam, phenobarbital, and phenytoin as initial therapy (level
U).
13. Q1. Which Anticonvulsants Are Efficacious as
Initial and Subsequent Therapy?
The following conclusions were drawn. In PEDIATRICS
Intravenous valproic acid has similar efficacy but better
tolerability than IV phenobarbital as second therapy after
failure of a benzodiazepine. (level B)
Insufficient data exist in children regarding the efficacy of
phenytoin or Levetiracetam as second therapy after
failure of a benzodiazepine (level U).
15. QUESTION TO BE ANSWERED
Q1. Which Anticonvulsants Are Efficacious as Initial and Subsequent
Therapy?
Q2. What Adverse Events Are Associated With Anticonvulsant
Administration?
Q3. Which Is the Most Effective Benzodiazepine?
Q4. Is IV Fosphenytoin More Effective Than IV Phenytoin?
Q5. When Does Anticonvulsant Efficacy Drop Significantly (i.e., After How
Many Different Anticonvulsants Does Status Epilepticus Become Refractory)?
16. Q2. What Adverse Events Are Associated With
Anticonvulsant Administration?
The following conclusions were drawn. In ADULTS
Respiratory and cardiac symptoms are the most common encountered
treatment-emergent adverse events associated with IV anticonvulsant
administration in adults with status epilepticus. (level A).
The rate of respiratory depression in patients with status epilepticus treated
with benzodiazepines is lower than in patients with status epilepticus treated
with placebo (level A), indicating that respiratory problems are an important
consequence of untreated status epilepticus.
No substantial difference exists between benzodiazepines and phenobarbital
in the occurrence of cardiorespiratory adverse events in adults with status
epilepticus (level A).
17. Q2. What Adverse Events Are Associated With
Anticonvulsant Administration?
The following conclusions were drawn. In PEDIATRICS
Respiratory depression is the most common clinically significant treatment-
emergent adverse event associated with anticonvulsant drug treatment in
status epilepticus in children (level A).
No substantial difference probably exists between midazolam, lorazepam,
and diazepam administration by any route in children with respect to rates of
respiratory depression (level B).
Adverse events, including respiratory depression, with benzodiazepine
administration for status epilepticus have been reported less frequently in
children than in adults (level B).
18. QUESTION TO BE ANSWERED
Q1. Which Anticonvulsants Are Efficacious as Initial and Subsequent
Therapy?
Q2. What Adverse Events Are Associated With Anticonvulsant
Administration?
Q3. Which Is the Most Effective Benzodiazepine?
Q4. Is IV Fosphenytoin More Effective Than IV Phenytoin?
Q5. When Does Anticonvulsant Efficacy Drop Significantly (i.e., After How
Many Different Anticonvulsants Does Status Epilepticus Become Refractory)?
19. Q3. Which Is the Most Effective Benzodiazepine?
The following conclusions were drawn. In ADULTS
In adults with status epilepticus without established IV access,
IM midazolam is established as more effective compared with IV
lorazepam (level A).
No significant difference in effectiveness has been demonstrated
between lorazepam and diazepam in adults with status
epilepticus (level A).
20. Q3. Which Is the Most Effective Benzodiazepine?
The following conclusions were drawn. In PEDIATRICS
In children with status epilepticus, no significant difference in
effectivenesshas been established between IV lorazepam and IV
diazepam (level A).
In children with status epilepticus, non-IV midazolam
(IM/intranasal/buccal) is probably more effective than diazepam
(IV/rectal) (level B).
22. QUESTION TO BE ANSWERED
Q1. Which Anticonvulsants Are Efficacious as Initial and Subsequent
Therapy?
Q2. What Adverse Events Are Associated With Anticonvulsant
Administration?
Q3. Which Is the Most Effective Benzodiazepine?
Q4. Is IV Fosphenytoin More Effective Than IV Phenytoin?
Q5. When Does Anticonvulsant Efficacy Drop Significantly (i.e., After How
Many Different Anticonvulsants Does Status Epilepticus Become Refractory)?
23. Q4. Is IV Fosphenytoin More Effective Than IV Phenytoin?
The following conclusions were drawn:
Insufficient data exist about the comparative efficacy of
phenytoin and fosphenytoin (level U).
Fosphenytoin is better tolerated compared with
phenytoin (level B).
When both are available, fosphenytoin is preferred based
on tolerability, but phenytoin is an acceptable alternative
(level B).
25. QUESTION TO BE ANSWERED
Q1. Which Anticonvulsants Are Efficacious as Initial and Subsequent
Therapy?
Q2. What Adverse Events Are Associated With Anticonvulsant
Administration?
Q3. Which Is the Most Effective Benzodiazepine?
Q4. Is IV Fosphenytoin More Effective Than IV Phenytoin?
Q5. When Does Anticonvulsant Efficacy Drop Significantly (i.e.,
After How Many Different Anticonvulsants Does Status Epilepticus
Become Refractory)?
26. Q5. When Does Anticonvulsant Efficacy Drop Significantly
(i.e., After How Many Different Anticonvulsants Does Status
Epilepticus Become Refractory)?
The following conclusions were drawn
In adults, the second [7%] anticonvulsant administered is
less effective than the first [55 %] “standard” anticonvulsant,
while the third anticonvulsant administered is substantially
less effective than the first “standard” anticonvulsant [2.5%]
(level A).
In children, the second anticonvulsant appears less effective,
and there are no data about third anticonvulsant efficacy
(level C).
32. Status Epilepticus: First-line Treatment Options
Benzodiazepine Route Dosing
Maximum
Dose
Class &
Level of
Evidence
LORAZEPAM IV 0.1mg/kg
4mg @
2mg/min
May repeat x1
in 5-10 min
Class I
Level A
MIDAZOLAM
IM
Nasal
Bucca
l
0.2mg/kg 10mg
Class I
Level A
DIAZEPAM PR 0.2mg/kg 20mg
Class IIa,
Level A
Brophy GM et al. Neurocrit. Care 2012; 17:3–23 [PubMed]
33. Status Epilepticus: Second-line Treatment Options
AED Route Dosing
Maximum
Rate of
Infusion
Additional
Dose
Class &
Level of
Evidence
Fosphenytoin IV 20 PE/kg
150
PE/min
5 PE/kg ,
10 min after
loading dose
Class IIa
Level B
Phenytoin IV 20mg/kg 50mg/min
5-10mg/kg,
10 min after
loading dose
Class IIa
Level B
Valproate
Sodium
IV
20-40
mg/kg
3-6
mg/kg/min
20mg/kg,
10 min after
loading dose
Class IIa
Level A
Return to index
34. Refractory Status Epilepticus:
Treatment Options
Infusions Initial Dose
Continuous
Infusion
Class &
Level of
Evidence
Adverse
Effects
Midazolam
0.2mg/kg
@ 2mg/min
0.05-2mg/kg/hr
Class IIa
Level B
Respiratory
depression
Hypotension
Propofol
1-2mg/kg
@ 20mcg/kg/min
30-200
mcg/kg/min
Class IIb
Level B
Respiratory
Depression
Hypotension*
Propofol infusion
syndrome
Renal Failure
Pentobarbital
5-15 mg/kg
@ ≤ 50mg/min
0.5-5mg/kg/hr
Class IIb
Level B
Respiratory
depression
Hypotension
Cardiac depression
Paralytic Ileus
Prolonged mental
status depression
Brophy GM et al. Neurocrit. Care 2012; 17:3–23 [PubMed]
35. RSE basic info
Etiology broadly assigned
to one of five groups
1. Drug/toxins
Shorvon S and Ferlisi M. Brain 2011
Betjemann JP and Lowenstein DH. Lancet Neurol 2015
Turnbull D and Singatullina N. Minerva Anestesiol 2013
36. RSE basic info
Etiology broadly assigned to
one of five groups
1. Drug/toxins
2. Infectious
Shorvon S and Ferlisi M. Brain 2011
Betjemann JP and Lowenstein DH. Lancet Neurol 2015
Turnbull D and Singatullina N. Minerva Anestesiol 2013
37. RSE basic info
Etiology broadly assigned
to one of five groups
1. Drug/toxins
2. Infectious
3. Structural
Shorvon S and Ferlisi M. Brain 2011
Betjemann JP and Lowenstein DH. Lancet Neurol 2015
Turnbull D and Singatullina N. Minerva Anestesiol 2013
38. RSE basic info
Etiology broadly assigned
to one of five groups
1. Drug/toxins
2. Infectious
3. Structural
4. Metabolic
Shorvon S and Ferlisi M. Brain 2011
Betjemann JP and Lowenstein DH. Lancet Neurol 2015
Turnbull D and Singatullina N. Minerva Anestesiol 2013
39. Status Epilepticus : Think TIME
• Time to treatment needs to be shorter.
• Response to treatment is time dependent.
• Morbidity and mortality are related to etiology
and duration (time) of status epilepticus.
• Subsequent epilepsy may depend on the
duration (length of time) of the status
epilepticus.
• Prolonged seizures predict future prolonged
seizures.