Status Epilepticus.

Valmiki K. Seecheran | Year V MBBS.UWI Cave Hill.

Objectives.

• To understand signs and symptoms.• To understand the causes.• To understand the types of treatment.• To understand the prognosis.• To understand epidemiology.

Introduction.

• Status epilepticus.– Medical Emergency.– Life threatening.– Persistent seizure.– ‘One continous, unremitting seizure lasting longer

than 5 minutes OR reccurent seizures without regaining consciousness between seizures for greater than 5 minutes.’

– Mortality rate is 20%.

Signs & Symptoms

• Convulsive– Epilepsia partialis continua ( recurrent motor epileptic

seizures).– Vascular disease, tumours & encephalitis.– Generalized myoclonus – comatose patients following CPR –

catastrophic damage to neocortex.• Nonconvulsive

– Complex partial status epilepticus (CPSE)• Temporal lobe.

– Absence status epilepticus.• Entire brain ( EEG is needed to diffrentiate between both types)• Long lasting stupor, staring and unresponsiveness.

Causes.

• 25% of people who have seizures or status epilepticus have epilepsy.– Stroke.– Nerve gas exposure.– Hemorrhage.– Insufficient dosage of medication.– Consumption of alcoholic beverages/ Dieting/ Fasting/

Gastroenteritis while on anti-convulsants.– Sleep deprivation.– Sudden withdrawal from a seizure medication.

• Benzodiazepine withdrawal syndrome.

Treatments• Barbiturates.

– Barbituric coma (induced coma).– Phenobarbital – 1st line.– Thiopental/ pentobarbital for emergencies.

• Benzodiazepines.– Lorazepam.

• Relatively long duration of action and rapid onset (2-8 hours).

• Phenytoin, Fosphenytoin.– 15-30 mins onset of action.– Co-administered with a benzodiazepine/ barbiturate.

• Valproate.• Propofol & Ketamine.

– Last resort.

Prognosis.

• 1 in 5, who have the disease, a total of 42, 000 annually will die within 30 days of having an initial SE seizure.

• Most likely aetiology – brain tumour, infection, trauma or stroke.

Epidemiology

• 40 cases of SE occur per 100,00 people.

Thank you.