MANAGEMENT OF SEIZURES AND STATUS EPILEPTICUS MOHW August 2020

Adapted from the guidelines Assessment Panels, CGAP,Norfolk and Norwich University Hospitals, NHS foundation Trusts /NICE

A seizure, formally known as an epileptic seizure, is a period of symptoms due to abnormally excessive or
synchronous neuronal activity in the brain.

Seizure type

● Focal seizure

● Generalized Tonic-Clonic seizure

● Absence seizure

● Myoclonic Seizure

● Tonic or atonic seizure

Status epilepticus – more than 30 minutes of continuous seizure activity or two or more sequential
seizures without full recovery of consciousness between seizures

Status epilepticus can represent:

⮚ An exacerbation or pre-existing seizure disorder

⮚ The initial manifestation of a seizure disorder

⮚ An insult other than a seizure disorder

MANAGEMENT WORK UP
Laboratory investigations

● Random blood sugar

● Serum electrolytes including serum calcium and magnesium

● Complete blood count

● Liver function test

● Renal function test

● Toxicology screen

● Anticonvulsant levels

● Arterial blood gas

● Urine analysis and urine toxicology

● Cardiac – ECG, troponins and oxygen saturation monitorings

● Consider the following during general and neurological examinations

- Trauma
- Infection
- Stroke
- Drug poisoning

● As indicated
- Chest Xray
- CT Scan and MRI of Brain
- Blood cultures
- CRP and ESR
- ANA if suspicion of connective tissue and disorder
- Blood Toxicology
- Lumbar puncture, if fever and confusional state hours or days prior to convulsion
- N.B : Lumbar puncture only after CT or MRI of brain

● Electroencephalogram ( EEG)
- EEG only to perform to support a diagnosis of epilepsy
- Not to be used to exclude a diagnosis of epilepsy
- To be used to determine seizure type and epilepsy syndrome
- To assess seizure recurrence
MANAGEMENT OF GENERALIZED CONVULSIVE SEIZURE AND STATUS
EPILEPTICUS IN ADULTS
1. Protect the airway, assess breathing and give oxygen.

2. Assess circulation and insert IV cannula

3. If seizure does not resolve spontaneously or is intermittent with no recovery of conscious level

● Diazepam 0.1mg/kg over 5 minutes slowly.

4. Repeat once after 10 minute if seizure is not controlled

5. Check blood glucose and treat if < 5 mmol/l. Administer glucose (50ml of 50%dextrose) and/or IV
thiamine 250mg, as high potency IV Pabrinex ,if any alcohol abuse or impaired nutrition.

6. Where drug intoxication might be likely – consider also naloxone at 0.4 -2.0mg IV

6. If seizure continues for more than a further 10 minutes , give:

● Phenytoin IV 18mg/kg at a rate not exceeding 1mg/kg min with a maximum rate of 50mg/min.

● IV Phenorbarbital bolus of 10 - 15mg/kg single dose at a rate of 100mg/minute(Monitor respiratory

rate, ECG, BP during administration)

7. If seizure continues, consider administrating General Anaesthesia.