STATUS EPILEPTICUS

HISTORY
Biodata
7 month old male child Mubeen R/O Banaras
partially vaccinated K/C of cerebral palsy was
admitted via ER on 6th August 2020

Presenting complaints
 Shortness of breath – 15 days
 Increased frequency of fits – 3 days
HISTORY
History of Presenting Complaints
 According to the patient’s mother he was in his usual state of
health 15 days back when he developed shortness of breath. It
was associated with cough and nasal congestion. Cough was
non productive and was aggravated after feeding. He was
taken to a local clinic and prescribed oral antibiotics. His
symptoms were relieved.
 Patient was admitted to the hospital at birth because of
complaint of fits. He was prescribed ½ Tab. Phenobarbitone
HS. The patient was compliant with medication for four
months but stopped medication without medical consultation.
HISTORY
History of Presenting Complaints
 After stopping medication the patient started
experiencing fits 7-8 times per day. They were
generalized tonic clonic with loss of urine and frothing
seen from the mouth, lasted 2-3 minutes and stopped
spontaneously.
 For the last 2-3 days the patient has started having fits
15 times per day which are generalized, last 5-6
minutes, stop spontaneously and patient regains
consciousness after 10-15 minutes of the fit.
HISTORY
Past Medical History
 Patient was admitted in NICU at birth for 15 days and
diagnosed and treated for meningitis.
 Follow up in Neurology OPD

Past Surgical History

 Not Significant

Drug History
 Tab. Phenobarbitone till 4 months of age. Discontinued now.
HISTORY
Immunization History
 Partially vaccinated

Nutrition History
 Exclusively on breastfeed since birth

Birth History
 Antenatal: Unbooked case; mother was not vaccinated and did not take any
medicines during pregnancy.
 Natal: Delivered via SVD at term at CHK. Twin delivery. Twin did not survive.
Cried immediately.
 Post natal: Admitted in NICU for 15 days with complaints of fever fits and
increased tone.
HISTORY
Family History

Still birth due 8 yr 5 yr Died at 4th DOL

to CPD

Fourth product of a consanginous marriage. Twin died

after four days because of anemia.
No family history of TB, asthma, Hep b or c and DM
or HTN.
HISTORY
Developmental History
 Social smile – Not developed
 Neck holding – Not developed
 Sitting – Not developed
 Crawling – Not developed

Socioeconomic History
 Living conditions are not satisfactory
EXAMINATION
Male child with increased tone, and posturing landed
in ER
Vitals
OFC: 34 cm
HR: 165 beats/min Weight: 3.7 kg
RR: 32 breaths/min Length: 56 cm
RBS: 108 mg/dl
Temp: 37 C
BP: 90/68 mm/Hg
O2 Sat: 97%
EXAMINATION
Subvitals A + J – Cy – Cl – E – D –
CNS
GCS E1 V1 M3 5/15
Actively seizing. Pupils reactive but sluggish.
RUL RLL LUL LLL
Bulk reduced reduced reduced reduced
Tone increased increased increased increased
Power 3/5 3/5 3/5 3/5
Reflexes +3 +3 +3 +3
Plantars upgoing upgoing
EXAMINATION
CVS
S1+ S2+ nil
P/P palpable
CRT <2 sec

Respiratory
B/L EAE, HVB, B/L wheeze + crepts + recessions

GIT
Soft, nontender, liver edge palpable, spleen not palpable, gut sounds
audible
INVESTIGATIONS
Hb 10.9 BUN 7
MCV 83 Cr 0.2
MCH 28 Na 144
MCHC 33 K 3.5
TLC 11.3 Cl 106
N 69 Ca 8.8
L 28 Mg 1.9
Plat 500 Phos 4.8
CRP 8.1
PT 14.1
INR 1.35
PROVISIONAL DIAGNOSIS
 Bronchiolitis
 Status Epilepticus
TREATMENT

 NPO
 O2 via nasal prongs at 4l/min
 0.45% DS 300ml IV over 24hr
 Inj. Augmentin 110mg IV TDS
 Inj. Hydrocortisone 30mg (loading) then 7.5mg IV TDS
 Inj. Omeprazole 4mg IV OD
 Inj Phenytoin 75mg (loading) then 10mg IV BD
 Inj. Diazepam 1mg IV SOS
 Inj. Paracetamol 40mg IV SOS
 Inj. Lerace 75mg (loading) then 40mg IV BD
 Nebs with N/S, Atrovent and Ventolin
STATUS EPILEPTICUS

Definition
A continuous seizure lasting for 30 minutes or longer
without intervening return of consciousness.
OR
A seizure that is so prolonged or frequently repeated
so as to create a lasting epileptic condition.
ETIOLOGY
Neonate Child

• Hypoxic ischemic • Anticonvulsant withdrawal

encephalopathy • Infections
• Infection • Simple febrile seizures
• Inborn errors of metabolism • Metabolic or electrolyte
• Stroke abnormalities
• Congenital Malformations • Presentation of epilepsy
• Trauma
PATHOPHYSIOLOGY
 Seizure initiation is caused by an imbalance
between excitatory and inhibitory
neurotransmission leading to abnormal neural
impulses.
 Seizure threshold in children is lower than in
adults.
 Cerebral blood flow blood glucose and oxygen
utilization increase in the initial phases of a seizure
to maintain cerebral homeostasis. After 30 minutes
homeostatic failure begins.
MANAGEMENT
It is a MEDICAL EMERGENCY!
 Airway (hypoxia)

• Open and maintain airway

• Give high flow oxygen

 Breathing (grunting and tachypnea)

 Circulation (hypertension, shock due to sepsis,

bradycardia due to raised ICP)

 Check blood glucose: if hypoglycemic give 5ml/kg

IV dextrose 10%
COMPLICATIONS
 Brain damage and cell death occurs if a seizure
remains for 60 minutes
 There is venous congestion, petechial hemorrhages
and cerebral edema
 Raised ICP, alteration in blood brain barrier and
lactic acidosis
 There is dysfunction of autonomic nervous system
causing hypotension and shock
THANKYOU