aneandoingalulsanenuransuasuns anufin® onus, quiiiud Gafiunane, tried TwAwann miodzemmine maFnowimen? nucunnemand wninendovowuriy vous 40002 Status Epilepticus in Srinagarind Hospital ‘Somsak Tiamkao, Suthipun Jitpimolmard, Verajit Chotmongkol. Division of Neurology, Department of Medicine, Khon Kaen University, Khon Kaen, 40002. sums status eplenieus Se) dhun vas qnituanve moment ABdannrndePagad tAtun wiiedaugenssinwn al gna Fnqulseash undarmedutin soquiinen: ueiiouaryaraad Gonunnerfuaiun’ prusunemnaad uninenauveuutin Gihe: Gheluliumsineda se swine wa 2500 Boma 2599 Brasinwe: sf uamsfinwy: Glu se dunu 30 mm oma 1 me vhs 12:10 alan ini gonerl 25 70 UAE eplepsia parts continua 5 #98 uae 7 se wat \flulsraartnaririow suupues SE (GTC) dsenouau 1. ons afecton 7 790, nnn 6 #90, Post avest 3 71H, Suoke 2-208, Uromia 2 510, Sopsie 2 270, Hyperoomia Wee Hype tensive encephalopathy atinsay: 1 #10 unebbinaTuaaIMg 4 sr Shen GTC WFumsinePalomrean 18 Tu 26 sw (72.00%) Fmunieslurinas'siun phenytoin awieeh uae FndulslA dmrmadein ngu GTC gett 600% ary doulunsinnne sepsis wae: brain herniation aplue: sé duregnéumenysmand srivefmanion ‘uri CNS infection uscuymentiun Siasinedetinige By 5600% unewurinfuloudautun) 72.00% dlAfunasfiney Fiona Beane uflanonqans SE uneesmsiniey a tovic-donic seizure (GTC! Background: Status epllepticus (SE) is an emergency Condition and contributes to high mortality rate if patients were misdiagnosed and improperly managed Objective: To describe characteristics and manage- ‘ment of patients with SE in Srinagarind Hospital. Setting: Medical ward, Srinagarind Hospital, Faculty of Medicina, Khon Kaen University Patients: Patients diagnosed as SE, between 1990. 1996. Design: Descriptive study. Results: Thity cases wore diagnosed as SE, 18 male, and 12 female, Types of seizures were generalized tonic-clonic seizure (GTC) in 25 cases and epilepsia parials coninua in Scases. Seven cases were diagnosed as having epilepsy in the past. Causes of SE (G7C) were CNS infection in 7 cases, antiepileptic drug withdrawal in 6 cases, post arrest in 3 cases, stroke in 2 cases, uremia in 2 cases, sepsis in 2 cases, hyperglycemia in 1 case, hypertensive encep-halopathy in 1 case and unknown in 4.cases. Eightoon GTC patients were improperly managed (72.00%) the common causes were too low phenytoin for loading dose and incorrect diagnosis. Morality rate was 56.00%, cause of death were sepsis and brain herniation Conclusion: SE is an emergency concition, common causes were CNS infection and antiepileptic drug withdrawal and contributed to high mortality rate of 56.00%. Eighteen patients (72.00%) were improperly managed. undumdinyary 2540; 120), 6468 © Srinagarind Med J 1997; 12(2), 64-68 64 sundunservers 250; 122) « Srinagarind Med J 1997: 1202)aun omy unenace« Somsak Tiamkao et al unin Staus epilepticus GE) Sunazgndumenngrenant denutudesbinnsine ed cturoutossintan mnie iaegdudhialiuiternsiniunannnd 1 solu! lnudadiiinanunes St vanetlernetfiloedl |nninieweruuuainne 30 wiiveiie win 2 alt Tneludasseudnaituqagnuruninnds 30 wait Qplaudsiternreuunaaiauadson’ tulesimaanis- adm wurlzrannes 50,000 Aa 60,000 au sal wells ascindivetslifleinafuvew alssaevinlsering deanna 250000 ru devnlendiiennay SE envvait wuslodur maugansMudhnassishy enum Pasgns mifadeluavacuacvssare 60% ifaludilouttait levtilensnineyfiew’ aaneunarmuioerenudaad wdefisnanantieshild SafilovlAiunaaine lerantn uacyrattinwuethdoutunnlgagaiignaes ven sondiannsleequmenim nine nasesunndigguesiay reaunaleemmut dywdountstuninediloe se AoundhisnnentinAedunn: se 1K well srunaritionafnenigniests misfimeristinglseasrifioanamentts 1. srigmnesone SE 2. dhheldtuneineiiomreaudalal useing seemasineniibionnien: 3. darinraieFenestilon se Felungutlaty nosimnfiwanzanuae livia eniaAinw nnsfmndionssoan ngufllautlaiunasAneite rahuamwaaunengnenand erscunnennant wn Fmendemouury ergeisus 16 Taull *funsiieds SE aware wn. 2599 Bell win, 2699 nnednwawne sintigionee nanisfiow fpbutifiner 90 au aseneudaeunmnny 18 AM invade 12 iu dnerdounmnuclanavinty 3:2 ort waftughloumaranvindy 42.4 116-75 7) naman 239 7 1869 1) alinuesnaednlzenenudae generalized tonicconic status 25 718 WR: eplepsiapertais continua 5 ne Tlretearinedariewlaun teasain 7 20 Trai 6 ne lnnlaaweiets § mu Teadiwin waoniienaaes 1 270 Terfiuanes 1 21t wae dermato- myosiis 1 #90 anuaqnaeintugtlae eplepsia partais continva sis 5 nulfasmnametimstuiengs sefushoostuden valu 560 un den (400820 sin jon) srunqnaeéitungs generalized tonic-clonic status 25 790 MATUEAR 21 110 24.00%) Tongan 3 srutfingan 2 eruaqsauts uselsl manuarung 4 398 (16.00%! (ETH 1) moni 1 snommstintungutle generalized toriclone status eng énnw ow 1 msfindornizsemanesdiunars 7 (leauestniay 3 mu Gexuanoséniay 2 ru Museies 1 2wuRe cavemous sus trombophiebis 1 7) 2. rwrfivionreas 6 3. nmeeeyanelquasreuunultodleduyraian a dumrataea@ananes 5. annals 6 _amefindetunruatada 7. nrasihwneluitengs 8, _ rasan wuledings thypertonsive encephalopathy eBunduonitnvens 2840, 1202) « 65 Srinagarind Med 4.1997; 12(2)areautiningalulsmmnnaréuniund« ‘Status Epilepicus in Srinagarind Hospital mafnwnfenronalinafuutunary yun Jnwmuindihulafumsinenfloanesuifies Ten 25 rn Aridhafius 26.00% Guloufw@e 18 renan 25 sw (7200 %) ‘Wiuniinin five goo0 anaeulafumeinmaioanemannns 1 dune (onenai 2) mame 2. srmqreanreineisimanesy bundy {alot generalized tonicclone status mninquesmsimnibinansay v0 1. Whur phonon tun loading man 7 2, sunAtn phenytoin Tun’? loading #1 6 3. Flsdanvae Se fanaa a 4. Aedunne se dh 3 5, SinANN benzodazepine sins huang a 6, YWAEN phenobarbital Tun72 loading #7 2 aningreamainenitimnemuiiessan 1. wundbllAArdenne se 2, unnitrnnveuatinreduwisestiollla uavldlaAnentaiintistmsinerfigndas SasnrndiuFiamy 14 su en 25 sb 65.00%) sawrrendit generalized tonic conic stats lefennn tamenguilafunsimeiibioareen 18 ru nun WGuFingsds 12 9 Ania 60.67% uaenguilatunrs Fowafionnsen 7 sn munradeTniin 2 0 Raul 2857% saresmnauvintmavinnnemsiade Tunreuslafin avazimumwesgnnariuuee 1 even maianulagady daulunguniednane 5 nell unas Farsi sonnrsfinengiaunn: Se 30 sy muNAT ELON rirunauey aiiayeannaginne 2 uae hur misting 25 29 uaemeiniawet 5 278 domrniannetila 5 nelufinannnnastimeludeags ness ongesiuintifion sinh soutwnjiumrinen ich misinwafiloungadiemeanazfunhmaluaealiion sneqefunlteaias 200 unos, Taulaifinnrasrathuty 66 rBundumitoyars 2540 120) « malivaituin’ wmdiatadadhudtesnmunrasthene ‘Tuionqsuessiothitnernsinduedaeimewuwans ‘Tuntennam veal daimeuaensine unease Ghloungatu nqjuulan generalized tonic-clonic status 25 me git 7 210 hilenestnogdowsy 6 rwitegion ‘uyatniosesiranaeviusturelihincnay Se srungaes SE 25 210 Wear, 21 7H (86.00%) msn navfindersuuszarmdaunans uasmeugaeniwin dadoueumeutumesuiesdilaesileenat (onansit 3) nunrnuandrefemsintescuvnzesm douneremulounilunsanwriidenroutouty srusrupheureana usesinmsfineniilslusaqsan mitugen dqywnseanrsinerdilae se sannvatnwiinuiy 200% rovidhelAiumsimnmbionremudiensny- uutuneargmunsinn deeugearnatinembl waite 18 Tu 24 ary 75.00%) dinaannetinn suniishuaemstionatingulzenn Soewaniiendn shesuhlelMnunetiauwlpiaeaanang une FnwFounndiiquatnerdiaubidierasidludess mneril 3 arviqees sta enoptus Chang CW TiamkaoS Cause Ge (N=TBB)——% (N=28) Percent Percent Anticonvulsant withdrawal 25.50 24.00 14.00 : ‘cohol elated Drug toxicity “50 (ONS infection 350 23.00 Cerebral tumor 475 : Trauma 3.25 : Refractory epilepsy 16.00 : Stoke 18.50 300 Metabolic disorders 725 12.00 Cardiac arest 2512.00 Sess 8.00 Hypertension en) Unknown 1150 16.00 inagarind Med J 1997; 12(2)auf diuwsh uasmale + Somsak Tiamkao et al possi 4 wamalfitlumsinsnnns 1s Epilepticus ‘Time from initial observation and Procedure treatment (minutes) ° Assess cardiorespiratory function.{f unsure diagnosis, observe 1 tonic-clonic ‘seizure and verty the persistence of unconsciousness after the seizure. \nser oral away and administer O, it necessary. Insert an indweling IV catheter Draw venous blood “sat” levels of anticonvulsant, glucose.electralytes,and urea. Draw arterial blood for ‘stat” pH,PaO,,HCO,. Monitor respiration, blood pressure, and ECG.If possible, monitor EEG. 5 ‘Start 1V infusion through indwelling venous catheter or normal saline containing thiamine 100 mg, Infuse 50 cc af 50% glucose to rule out hypoglycemia seizure, In children, the dosage of glucose is 2 mig af 25% glucose. 10-20 ‘Adiminister either lorazepam 0.1 mg/kg at 2 mg/min or diazepam 0.2 mg/kg at 2 mgimin it ciazepam is given, itean be repeated i seizure do not stop alter § minutes. 21-60, IW status persists, administer phenytoin 15-20 mg/kg no faster than 50 mg/min Inadults and 1 mg/kg /min in children IV. Monitor ECG and blood pressure during the infusion. Phenytoin is incompatible with glucose- containing solutions; the IV line shoud be purged with normal saline before the phenytoin infusion. 60+ If status does not stop after 20 mgrkg af phenytoin, give additional doses of 5 mgikg to a maximal dose of 30 mak, I status persist. intubation via endotracheal ube is mandatory. Give phenobarbital IV 20 mg/kg at 100 mg iin. When phenobarbital is given ater a benzodiazepine, the risk of apnes or hypopnea is areat.and assisted vention usualy is requred. If satus persists, give anesthetic doses of drug such as phenobarbital or pentobarbital. Ventilatory assistance and vasopressors are almost always necessary. Options for Drug-Resistant Convulsive Status I¥seizures continue, general anesthesia can be instituted with either: 1. IV pentobarbital, loading dose of 15 mg/kg over 1 hour is followed by maintenance infusion of 1-2 mg/kg/h until seizures stop or EEG burst suppression. 2. IV phenobarbital, additional 5-10 mg until seizures stop or EEG burst suppression. 3. Thiopentone may be given at 2 mg/min in normal saline by a microdrip set for 30-60 minutes, Reduce dosage to 0.5 mgimin wnen antiolied. Dose can be increased to anesthetic levels if necessary to achieve control. EEG monitoring to ascertain a "burst-suppression’ pattern and seizure control is required. Alternatively, other anesthetizing barbiturates can be used. 4. Once controtis achieved, EEG monitoring is recommended continuously or as frequently ass technically possible in the obtunded patient, to ensure that electrographic status has not recurred sGuniiendinwera 2540; 122) « Srinagarind Med J 1997; 122) 67areautningalutzanonnardunduns + Status Enlpicus in Srinagarind Host aaron Wieewmrertnfignteda uudlett mefnwniilon se unniielqi@anannrgyune Sourignieddadioulflunisdetnedanns 9 were Ha) Tha 6 tu 26 seg (25.00%) hagrnmstied fannsomitesri-iemauftadatananadend atau invaiafennae se Tufaloetitermsinnsegmunny useing Rebunndine aiounenuamngrnnan wilolé dofiecuhiadsadhloufieuanssinw ninety andarmnaetnacls Tous lundualatum ines Fhlumnvansetinrnadetings’s 66.67% ihe affuuiourtungstAtumstnntimnesateades 23.57% aqdaamsfion Se Dun negnidumamnysmantfihusiiuies ‘Wiuniinduuecinenfigntecasineranda sun sunieeldui nnaindeseuunlssandauny ane mianyouriudnnseiudiuaesdilomdutsaanin unmldqulunésWineinwwilsimnan Fsenuqnes mainnflunnvanthaduannatenroutlyta Fovuntusueunndaanfisnae SE uscilpiaern snangnumsimnitinndaultimushaets 9 dant Hownfigndassssiandauannsinena manronasan madisFinnesfihuesadaawn sonens81988 1. Trescher WH, Lesser RP. The epilepsies. In: Brad- ley WG.ed. Neurology in cnial practice, New York Butterworth-Heinemann, 1996: 1625 54. 2. Aminof-MJ, Simon RP'Status epilepticus: cause, clinical features.and consequences in $8 patients ‘Am J Med 1980; 69: 657-66. 3. Tiamkao S, Pratipanawatr T, Nitinavakarn 8, Chotmongkol V, Tiamkao Si, Jitpimmaolrd 8. Seizure in non-ketotic hyperglycemia. Presented at the Annual symposium, Faculty of Medicine, hon Kaen University, 1984 4. Chang CWJ, Bleck TP.Status epilepticus. In Jordan KG, ed.Neurolagic clinics. Philadelphia WB. Saunders, 1995: 529-48 68 Suniuniioaarn 2540; 120) © Srinagarind Med J 1997; 1202)