Transcript Status epilepticus

Ass. Prof. Hadi Mujlli
MSc, PhD Neurology
Head of Med. Dep. Thamar Medical College,
Thamar University
Definition
develop into Prolonged or clustered seizures sometimes
non-stop seizures. Status epilepticus (SE) is a common,
life-threatening neurologic disorder that is essentially an
prolonged epileptic crisis. Status epilepticus is a acute,
medical emergency.
Prolonged or clustered seizures sometimes develop into
non-stop seizures,
Status epilepticus is a medical
emergency.
It requires hospital treatment to bring
the seizures under control. If your child
has had episodes of non-stop seizures
that had to be treated in the emergency
room, you will want to have a plan of
again. action ready in case they occur
SE can represent an exacerbation of a
preexisting seizure disorder, the
initial manifestation of a seizure
disorder, or an insult other than a
seizure disorder. In patients with
known epilepsy, the most common
cause is a change in medication. Most
seizures terminate spontaneously.
Signs and symptoms
By clinical history, nonmotor simple partial status
epilepticus involves subjective sensory disturbances,
including the following:
Focal or unilateral paresthesias or numbness
Focal visual changes, usually characterized by flashing
lights
Focal visual obscuration or focal colorful hallucinations
Olfactory or gustatory hallucinations
Atypical rising abdominal sensations
Epilepsy partialis continua, or focal
status epilepticus of the motor
cortex, may occur in various
contexts, with some authors
subdividing it into type I
(nonprogressive) and type II
(progressive).
Type I epilepsy partialis continua features
include the following:
Intermittent, semi-rhythmic, involuntary
twitching involving a discrete subset of
muscles
Most commonly affects the face and
ipsilateral distal hand musculature
Myoclonus of this variety may evolve into
partial or generalized convulsion
Type II epilepsy partialis continua features
include the following:
Usually linked with Rasmussen encephalitis
Gradual loss of unilateral function, with
parallel focal or unilateral hemispheric
atrophy
Impaired intellectual skills to various
degrees
Possible effect on language skills
Type I complex partial status
epilepticus refers to recurrent,
recognizable complex partial
seizures without recovery between
seizures. Type II represents
continuous, ongoing complex partial
seizure activity.
Diagnosis
Examination for status epilepticus includes the
following:
- Generalized convulsive status epilepticus: Typical
rhythmic tonic-clonic activity, impaired consciousness.
- Status epilepticus due to possible mass lesion or brain
infection.
- Any patient without improving level of consciousness
within 20-30 minutes of cessation of generalized seizure
activity
Pharmacotherapy
Most patients with status epilepticus
who are treated aggressively with a
benzodiazepine, fosphenytoin, and/or
phenobarbital experience complete
cessation of their seizures. If status
epilepticus does not stop, general
anesthesia is indicated.
laboratory studies
- Glucose and electrolyte levels (including calcium,
magnesium)
- Complete blood count
- Renal and liver function tests
- Toxicologic screening and anticonvulsant drug levels
Other tests
- Electroencephalography
- Blood cultures
- Urinalysis and/or cerebrospinal fluid
analysis
- CT scanning and/or MRI of the brain
- Chest radiography
Management
Aggressive treatment is necessary for
status epileptics. Clinicians should
not wait for blood level results
before administering a loading dose
of phenytoin, regardless of whether
the patient is already taking
phenytoin.
Medications
- Benzodiazepines (eg, lorazepam,
diazepam, midazolam): First-line agents
- Anticonvulsant agents (eg, phenytoin,
fosphenytoin)
- Barbiturates (eg, phenobarbital,
pentobarbital)
- Anesthetics (eg, propofol)
Essential update:
Ketamine treatment in refractory status
epilepticus In a retrospective review of
patients with status epilepticus
refractory to typical antiepileptic drugs,
ketamine was found to be effective
and safe as an adjunctive treatment
in all the patients
Supportive therapy
- Maintenance of vital signs
Airway, breathing, circulation (eg,
hemodynamic/cardiac monitoring)
- Respiratory support, with
intubation and/or mechanical
ventilation if necessary
- Periodic neurologic assessments
Surgery
- Surgical
intervention for status
epilepticus is a last resort and rarely
performed
- Operative procedures depend on the
etiology
- hemispherectomy, subpial resection,
or placement of a vagus nerve
stimulator.
REFFENCES
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Status Epilepticus
Author: Julie L Roth, MD; Chief Editor: Stephen A
Berman, MD, PhD, MBA
Fundation of Epilepsy.
THANKS