Health science

1. BCM/K/0009/2021
STATUS EPILLEPTICUS

2. INTRODUCTION
• Status epilepticus is the occurrence of a single unremitting seizure
with a duration longer than 30 minutes or frequent clinical
seizures without return to consciousness.
• It can also be defined as continuous seizure activity;onset can be
generalized or focal.
• Status epilepticus has 2 forms:
convulsive
Nonconvulsive

3. Generalized convulsive status epilepticus
• It involves at least one of the following:
• a)Tonic- clonic seizure activity lasting >5minutes
• b)>2seizures between which patients do not full regain
consciousness.

4. Non convulsive status epilepticus
• Includes focal- onset status epilepticus and absence status
epilepticus .
• These seizures often manifests as prolonged episodes of mental
status changes.

5. Aetiology
• Non-compliance to antiepileptic drugs.
• Withdrawal syndromes from alchohol,benzodiazepines,barbitirates.
• Drug toxicity (antidepressants,cocaine,opiates,salicytes)
• CNS infection including Cerebral malaria.
• Trauma and stroke.
• Cerebral tumor.
• Refractor epilepsy.
• Metabolic abnormalities.
• Other causes can be idiopathic.

6. Systemic complications .
• Metabolic – lactic acidosis.
• Hypoxia
• Rhabdomyolysis .
• Aspiration pneumonia.
• Hyperplexia.
• Arrythmias.

7. Management.
• Status epilepticus is a medical emergency.
• The goal is to stop seizures as soon as possible and maintain oxygen
circulation.
• Hence it is important to know the sequential protocol for treatment
with benzodiazepines , barbiturates and phenytoin.
• Assessment for etiology and lab investigations.
• Obtaining IV access and initiating therapy.

8. Status epilepticus management algorithm
• ABC 100%, Oxygen.
• Take a brief history and do a neurological examination.
• Serum electrolytes ,BUN, Glucose, CBC , Toxic screen ,drug levels
,blood gases.
• IV NS
• If hypoglycemic, give 5ml/kg of 10% dextrose.
• Follow the protocol for anticonvulsants :Diazepam, phenytoin,
phenobarbitone.

9. Refractory Status epilepticus
• May need to initiate comma .
• Patient should be in ICU.
• Bedside EEG.
• Several options ; -Phenobarbital 5mg/kg then infusion 0.5-
5mg/kg/hr
-propofol 1mg/kg then 2-4 mg/kg/hr.
-Midazolam 0.2 kg/kg then 0.05 -0.5 mg/kg/hr.
-General anesthesia(Halothane)

10. REFERENCES
Hutchisons textbook of paediatrics
Clinical emergency medicine
Davidson’s principles and practice og
medicine -22nd edition.
Harrison’s principle of internal
medicine.

11. END.