STATUS

EPILEPTICUS
 DEFINITION
• SE has typically been defined as repetitive
seizure lanting 30 minute or longer, or seizures
without full return of consciousness between
episodes
• SE as 5 minutes of continuous seizure activity,
or two or more discrete seizure with no
intervening recorvery of consciousness.
DESCRIBE THE CLASSIFICATION AND CLINICAL
PRESENTATION OF SE
Generalised convulsive SE (GCSE)
Seizure are primary or
secondarily generalised and
the patient has generalised
tonicand/ or clonic
convulsive movements
without loss of
consciuousness
Non-convulsive SE (NCSE)
There is altered
consciuousness and EEG
evidence of seizures without
convulsive movements.
NCSE may evolve from
GCSE when electrical
seizure activity continues
with loss of motor
manifestation
 PATHOPHYSIOLOGY

• The major inhibitory mechanism in the

brain is γ-aminobutyric acid A (GABA
a)receptor-madiated inhibition
• Excitatory mechanism are predominantly
via glutamine acting in NMDA
receptors.NMDA receptors increase on
synapses during ongoing epileptic The pathophysiological
activity, facilitating neuronal excitability effects of seizure from both
direct excitotoxic neuronal
and persistence of seizure. injury and secondary injury

Hypotension Hypoxia Hyperthermia

Aetology
Aetology
 Management of SE
GCSE One of the few randomised, double-blind clinical trials
for treatment of GCSE fount that lorazepam,
phenobarbital or diazepam followed by
phenytoin.

NCSE
Clinical response to intravenous benzodiazepine is
predictive of a good outcome
 Protocol for management SE

1. Assess A, B, C, GCS
2. Give O2 an consider need for intubation/ventilation
3. Monitor bool pressure, ECG, pulse oxymetry
4. Obtain i.v access and draw blood for investigations
5. Of patient is hypoglicemic or if blood glucose
estimation is not available, give glucose.
6. Seizure control
 First-line treatment
Lorazepam remains the first-line AED despite the
risk for respiratory depression.
• A target total dose of 0,1mg/kg i.v at 2mg/min
up total dose 10mg
• Diazepam 0,2mg/kg i.v at 5mg/min up to total
dose of 20mg
If diazepam stops the seizure, phenytoin should
be given next to prevent recurrence
 Second-line treatment
Phenytoin load with 18 to 20 mg/kg ( if the patient is not already
being given phenytoin) can given only in normal saline solution to
prevent precipitation and is usually administreted at a maximum
rate of <50mg/minute

Monitor blood pressure and the

ECG during infusion.
If hypotension or arrhytmias
develop, stop or slow
 Third-line treatment
Traditionally, phenobarbital (15-20mg/kg loading
dose has been recommended, given at a rate no
faster than 50-100 mg/min until the seizure stop.
Maintenance therapy 1-4mg/kg/day
• Slow bolus 3-5mg/kg
Thiopental • Infusion 1-5mg/kg/h

• Slow bolus 1-2 mg/kg

Propofol • Infusion 2-5mg/kg/h

• Slow bolus 0,1-0,2 mg/kg

Midazolam • Infusion 0,1-1,0mg/kg/h