STATUS EPILEPTICUS

Introduction

The term "Status Epilepticus" is also known as acute prolonged seizure activity. This is a generalized
seizures that occur without full recovery of consciousness between attacks ( Rice et al.,2005).

The term status epilepticus has been broadened to include continuous clinical or electrical seizures (on
EEG) lasting for at least 30 minutes even without impairment of consciousness.

Status epilepticus is a medical emergency. Vigorous muscular contractions impose a heavy metabolic
demand and can interfere with respiration. Respiratory arrest at the height of each seizure produces
venous congestion and hypoxia of the brain. Repeated episodes of cerebral anoxia and edema may lead
to irreversible and fatal brain damage.

Factors that facilitate status epilepticus include

 Withdrawal of antiseizure medication.

 Fever.

Concurrent infection.

Medical management of headache

The goal of treatment is to stop seizures as quickly as possible, to ensure adequate cerebral
oxygenation and to maintain the patient in a seizure-free state.

 An airway and adequate oxygenation is established if the patient remain unconscious

and unresponsive, a cuffed endotracheal tube is inserted.
 Intravenous diazepam (Valium), lorazepam (Ativan), is administered slowly in an attempt to halt
seizures immediately.
 An IV line is established and blood samples obtained to monitor serum electrolytes, phenyotin
and glucose levels.
 Vital signs are monitored on a continuous basis.
 If initial treatment is unsuccessful, general anesthesia with a short acting barbiturate may be
used.

Serum concentration of the antiseizure medication is measured because a low level suggests that
patient was not taking the drugs or the dosage was too low. This could cause postictal cerebral
edema or respiratory depression.

Nursing management of headache

 The nurse initiates ongoing assessment and monitoring of respiratory and cardiac function
because of the risk for delayed depression of respiration and blood pressure secondary to
administration of antiseizure medication.
 The patient is turned to lie down in a lateral position. Pharyngeal secretions are drained if
possible.
 The nurse monitors the IV line closely so it does not dislodge during seizures.
 During seizures, the nurse should protect patient from injury with the use of seizure precautions
and close monitoring.