STATUS

EPILEPTICUS

DEFINITION
Single unremitting seizure with a duration
longer than 10 minutes
or
frequent clinical seizures without an interictal
return to the baseline clinical state

FIGURES
Around 5% of adult with epilepsy will have one
episode of status epilepticus
The mortality can reach up to 20% depending on
many factors (underlying cause )

CAUSES
Antiepileptic drugs non
compliance or
discontinuation.
Drug over dose or
withdrawal
Anoxia
structural injuries (trauma,
infections,neoplasms etc )
Metabolic abnormalities (low
glucose, sodium, calcium
magnesium )

MANAGEMENT
4 principles
Stabilize patient
Antiepileptic drugs
Look for aetiology
Long term anticonvulsants

MANAGEMENT

Stabilize patient = ABCDE

Maintain

Airway- patient at risk

for aspiration
Breathing- place O2, be ready for
intubation
Circulation- obtain IV access
Dextrose: check glucose levels
Electrolytes: check electrolytes
(Na, Ca, Mg, PO4), and
anticonvulsent levels

MANAGEMENT
Anti epileptic drugs
Start by benzodiazpeine preferably lorazepam 4
mg iv or diazepam 10-20 mg
You may repeat the dose
If no IV access >> Midazolam 10 mg IM
Phenytoin infusion 10-20 m/kg or fosphenytoin
15-20 m PE/kg
If still uncontrolled despite infusion consider
general anesthesia plus EEG monitoring
Induced hypothermia

MANAGEMENT
Etiology :
Look for reversible etiologies
hypoglycemia ,electrolyte
disturbance
Focused history specially
drug history
Check FBC ,LFT ,urea and
electrolytes, consider ABG,
drug toxicology ,
anticonvulsant levels
Consider brain imaging
after control of seizures