FEBRILE SEIZURES

STATUS EPILEPTICUS
Status Epilepticus
A Neurological Emergency

• A prolonged seizure state lasting 30 minutes

or more
or
• More than 3 seizures occurring within 1 hour
• Patient seizes continuously or has seizure after
seizure without stopping
• Life threatening.
Status Epilepticus:
ED Management – First 5 Minutes
 Evaluate airway
 Suction, position and provide nasal airway .
 Provide 100% oxygen.
 Establish vascular access
 Draw labs as determined by history (examples:)
 CBC, Electrolytes, Blood glucose, Calcium,
Magnesium, Phosphorus
 Toxicology screen, if indicated by history
 Antiepileptic drug levels.
 Administer benzodiazepines
I/V Diazepam 0.1-0.3mg/kg/dose.
 Lorazepam IV 0.1 mg/kg
 No IV access, give either:
Diazepam PR 0.5 mg/kg (max PR dose = 20
mg) or
Midazolam IM 0.1 - 0.2 mg/kg
Status Epilepticus:
ED Management – Next 10 Minutes

 Reassess A, B, C’s

 Continue supportive airway management

 Suction, position and provide nasal airway .
 Provide 100% oxygen.

 Evaluate results of rapid blood glucose testing

If the seizure activity continues…
 Administer medications (per guidelines)
 Repeat IV Lorazepam 0.1 mg/kg
 Phenytoin 15-20mg/kg loading dose
Or
 Administer IV/IM Fosphenytoin 15 mg/kg loading dose
 Maintenance dose 4 to 8 mg/kg in 2-3 divided doses.
Status Epilepticus:
ED Management – Next 15 Minutes
Having administered 2-3 doses of Benzo- diazepines,
and a dose of Fosphenytoin without halting the
seizure, consider the patient in refractory Status Epilepticus .

Consult with Neurology and/or Intensivist for further

management recommendations
Status Epilepticus:
ED Management – Refractory SE
 If seizure activity persists (after appropriate doses of
benzodiazepines and Fosphenytoin), load with a
second long-acting AED that was not used
initially (e.g., Phenobarbital, Valproic acid).
 Paraldehyde.0.3 kg PR.
 Consider loading with Midazolam IV 0.1 - 0.2 mg/kg
 Manage with continuous EEG monitoring
 Contact PICU/NICU to begin transfer to higher level
of care.
 GA(PROPOFOL,Thiopentol) and mechanical
ventillation.
Status Epilepticus:
Test Yourself
1. You respond to an emergency call for a 4-year-old child. Mother found the
child on the floor of the playroom, unresponsive to voice with rhythmic
movements of both the upper and lower extremities. The parents also report
that the child has had seizures, starting at age 2. The seizure activity has
always lasted only about 1 minute. The parents called 9-1-1 when the initial
seizure stopped, but the seizure started again with about one minute in
between. They estimate the child has been seizing for about 15 minutes.
Your FIRST response is to:
A. Move the child to the bed
B. Establish vascular access
C. Protect/position the airway
D. Give rectal diazepam
2. How quickly should the first benzodiazepine be given after
status epilepticus begins?
A. At 30 minutes
B. At 20 minutes
C. Within 5 minutes
D. After 60 minutes

3. What drugs are used first in status epilepticus?

A. Lorazepam
B. Fosphenytoin
C. Diazepam
D. A and C
4. Who is likely to have status epilepticus?
A. Child with a history of epilepsy
B. Child with encephalitis
C. Child with a traumatic brain injury
D. All of the above
FEBRILE SEIZURES
SEIZURES associated with fever in the absence of
detectable CNS DISORDER.
Fever >39c:
9months-5 yrs of age,peak:14-18 months.
Family history.
Types of febrile seizures
1.Simple .
2. Complex
Simple:generalized,less than 15 min
complex.more than 15 min ,repeated,focal.
Risk of epilepsy
Risk factors:
1.Atypical seizures.
2.Family history of seizures.
3.<9months age at first time.
4.Underlying brain disorder.
9%risk of epilepsy.
Lab investigations

CBC.
S.electrolytes.
BSR(R)
S.ca,S.phosphate.
Blood c/s
CSF exam
Toxicology screening.
EEG
NEUROIMAGING.
Management
1.control fits.
2.antipyretics.
3.antibiotics
4.prophylaxis:
Temp lowering advice.
Diazepam:PR SUPPOSITORY.
Phenobaritone if complex fits,underlying brain disorder.
prognosis
Complex seizures…6%develop mesial temporal
sclerosis and later on CPS.
EPILEPSY
TWO OR MORE unprovoked seizures at an interval
more than 24 hrs apart.
Etiology
A.Idiopathic .
B.Secondary :
CNS infections.
Birth asphyxia.
Head trauma
Toxins and drugs
Feb convulsions
Metabolic disorders.
Neurocutaneous disorder
Inborn errors of metabolism
Vascular disorder.
Degenerative brain disorder
Brain tumours.
Congenital malformations
History
Age
Aura.duration,frequency.
Loss of conciousness
Type.gen or focal
Posictal
Triggers
h/o birth trauma
Feb seizure
Development of child
Drugs
Family history.
Examination
Anthropometry.
Skin
CNS exam
Development
Examine parents/sibs
Eye exam
Hepatosplenomegaly
Investigations
BSR
s/e
EEG
CRANIAL usg
CT scan brain
Cbc
Urine exam
Classification
GENERALIZED
of epilepsy
PARTIAL
Tonic clonic Simple partial:motor
Myoclonic Sensory
Absence ……typical,atypical Autonomic
Atonic Psychic.
Clonic Complex partial:
Tonic Psychomotor
Infantile spasm With sec generalisation
UNCLASSIFIED:
EPILEPTIC
syndromes:BPEC.LENNOX
GASTAUT etc
Management
Principles:
Remove the cause.
No previous anticonvulsant
First line
Od or BD dose
Not controlled….. Increase dose to max.
2nd line
Refrain cycling,horse riding,swimming,locking doors
when alone.
Antiepileptics
Gen tonic clonic :valproic
acid,phenobarbitone.phenytoin,etc
Absence,petit mal:ethosuximide.
Partial :carbamezipine,clonezepam.
Infantile spasms:cbz,clonezepam,ACTH,ne
antiepileptics.
NEW ANTIEPILEPTICS
Vigabatrin
Lamotrigine
Gabapentine
Felbamate.
Follow up
1-2 wks…..1-3 months.
PROGNOSIS:
75% GOOD COMPLIANCE no seizures.EEG before
withdrawl.