Status Epilepticus

Status Epilepticus (SE)

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Definition

30 minutes of continuous seizures or lack of recovery between discrete seizure for focal, complex partial, absence and other form of convulsive seizure
5 minutes of continuous convulsive seizures
3 discrete convulsions within an hour

Overview

Management

Take care of ABC
Draw blood for
- Electrolytes, CBC, Calcium, Magnesium, BUN, Liver function
- Anticonvulsant level, Alcohol, Toxicology screen
If hypoglycemia suspected, give 50% glucose
Give Thiamine 100 mg iv
Lorazepam 0.1 mg/kg iv
Load with Fosphenytoin 20 mg/kg of Phenytoin equivalent iv, not to exceed 150 mg/min. Some investigators believe that an additional 5 mg/kg dose should be administered before advancing to the next line of therapy.
If seizure persists
- give Phenobarbital 20 mg/kg iv at 50 to 100 mg/min
Review lab result and correct any abnormality
For refractory seizure, need Intubation, EEG monitoring and
- Pentobarbital 5-15 mg/kg loading over 3 minutes, 0.5 to 5 mg/kg/hr drip or
- Midazolam (Versed) 0.2 mg/kg loading, then 0.06-1.1 mg/kg/hr drip or
- Propofol 1-2 mg/kg loading, then 3-10 mg/kg/h
- to produce a EEG with no electrographic seizure or burst suppression pattern.

Treat complications of SE

Rhabdomyolysis:
- Normal
- Urinary alkalinization may be useful.
- If treatment of GCSE takes longer than expected because of hypotension or arrhythmias, neuromuscular junction blockade under EEG monitoring may be considered.
Hyperthermia:
- U
- External cooling usually suffices if the core temperature remains elevated.
- High dose pentobarbital generally produces poikilothermia.
Treatment of cerebral edema secondary to SE has not been well studied.
- SE and cerebral edema may be caused by the same underlying condition.
- Hyperventilation and mannitol
- Edema due to SE is vasogenic in origin, so steroids may be useful.

Other Tests as indicated

Further reading