DR Bisma Zakib

Dr Hania
Continuous seizures or repetitive, discrete seizures
with impaired consciousness in the inter-ictal period.
Duration of seizure activity should be 15-30 min.
Convulsive Status Epilepticus

1.generalized tonic
2. generalized clonic
3. generalized tonic- clonic
Nonconvulsive Status Epilepticus

1.complex partial status epilepticus

2.generalized absence status epilepticus
3. Myoclonic status
4. Neonatal status epilepticus
5.Epilepsia partialis continua
1. anticonvulsant withdrawal or noncompliance
2. acute cerebrovascular accidents
3. Metabolic
4. CNS infection
5. Alcohol/Drug toxicity
6. Hypoxia
7. Intra-cranial space occupying lesion
8. Trauma
9. Fever/infection
0-5 Minutes

Stabilize the patient

1. Oxygen, oral airway. Avoid hypoxia!

2. Consider bag-valve mask ventilation. Consider

intubation
3. IV/IO access. Treat hypotension, but NOT
hypertension
Cont…
1. Give glucose (100 ml D25%), unless normo- or
hyperglycemic
2. Hyperglycemia has no negative effect in SE (as
long as significant hyperosmolality is being
avoided)
3. Thiamin 100 mg IV - if given D25 or if
cachectic/malnourished/alcoholic
Labs :
 Na,K, Ca, Mg, PO4 , BUN, Cret, glucose

 CBC

 Liver function tests: ammonia

 Anticonvulsant level

 Toxicology

 Blood C/S

 Initial screening history and Physical examination

Rapid acting

plus

Long acting
 Benzodiazepines

Lorazepam 0.1- 0.15 mg/kg i.v upto 4-6 mg over

1-2 minutes If SE persists, repeat every 5-10 minutes
1. Phenytoin:- 20mg/kg Bolus dose IV at the rate of
50mg/min.
2. Fosphenytoin:- 20mg PE/kg Bolus dose IV at the
rate of 150mg/min (Repeat dose of 10mg/kg can be
given)
3. Valproate:-25 mg/kg IV
 General anesthesia should be induced
1. Propofol:- 2mg/kg IV bolus,Repeat if necessary,
followed by infusion (2 – 10 mg/kg/hr)
2. Thiopental:- 100-250mg IV bolus over 20 sec. with
further 50mg bolus every 2-3 min.until seizure
control followed by IV infusion(3-5mg/kg/hr)
3. Midazolam:- 0.3mg/kg IV bolus dose at the rate of
4mg/min, rpt every 5 min 3 doses followed by
infusion(2 ug/kg/hr)
If seizures have been controlled for 12hrs., reduce
the dose over further 12hrs.
If seizure recurs again GA agent should be given
Adults 26%

Children 3%