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The outcome of status epilepticus (SE) can be improved by facilitating early recognition and treatment with antiepileptic drugs. The purpose of this study was to analyze the treatment delay of SE in a prospectively recruited patient cohort. Improvements to the treatment process are suggested.
Can the treatment delay of status epilepticus be improved?
Conclusions Status epilepticus is a neurological emergency that will be encountered commonly by the neurohospitalist. Successful treatment will depend upon the mobilization of available resources and the rapid administration of anticonvulsant medications.
Is status epilepticus a neurological emergency?
Objectives: Status epilepticus (SE) is associated with high morbidity and mortality. The American Epilepsy Society (AES) has established guidelines regarding proper dosing of antiepileptic drugs (AEDs). There are also recommendations for appropriate weaning off anesthetic agents in SE.
Are antiepileptic drugs dosing guidelines appropriate for status epilepticus?
Complications of status epilepticus can be separated into medical and neurological complications and also immediate and delayed complications.
What are the complications of status epilepticus?
What happens if you don't treat status epilepticus?
Convulsive status epilepticus is a medical emergency. Get medical help right away if you have a convulsive seizure that lasts more than 5 minutes. Failure to get treatment right away could result in brain damage or even death.
What complication is associated with status epilepticus?
Acute complications result from hyperthermia, pulmonary edema, cardiac arrhythmias, and cardiovascular collapse. Long-term complications include epilepsy (20% to 40%), encephalopathy (6% to 15%), and focal neurologic deficits (9% to 11%).
What are the most serious complications associated with status epilepticus?
Medical complications include cardiac arrhythmia, cardiac damage because of catecholamine surge, respiratory failure, hypoventilation, hypoxia, aspiration pneumonia, pulmonary edema, fever, and leukocytosis are some of the common and serious complications seen in patients with status epilepticus[19].
How does status epilepticus cause brain damage?
Death or brain damage from status seizures (as opposed to death from the underlying cause) is most likely to result from: Direct damage to the brain caused by the injury that causes the seizures. Stress on the system from repeated generalized tonic clonic seizures. Injury from repeated electrical discharge in the brain ...
What are potential complications of seizures?
Seizures may lead to injuries, including falls, shoulder dislocation, burns, fractures, oral/tongue trauma, and urinary or bowel incontinence. Loss of memory and postictal state and even brain injury may result, as well as aspiration pneumonia, and if prolonged, rhabdomyolysis.
What are the causes of status epilepticus?
What causes status epilepticus?Stroke.Imbalance of substances in the blood, such as low blood sugar.Drinking too much alcohol or having alcohol withdrawal after previous heavy alcohol use.Withdrawal from medicines to treat seizures.
What is the prognosis of status epilepticus?
Status epilepticus (SE) is a neurological emergency, with a short term mortality of 7–39%.
Why is understanding status epilepticus important?
Very long seizures (i.e., status epilepticus) are dangerous and even increase the chance of death. It is important that these long seizures are identified early, so they can be treated early.
Can status epilepticus cause brain swelling?
Five children were identified, all of whom presented with fever-associated convulsive status epilepticus, developed severe brain swelling, and died.
Can a prolonged seizure cause brain damage?
To summarize, prolonged seizures can result in brain damage, while recurring seizures can also have adverse effects on brain functioning. In turn, traumatic brain injuries can also lead to various types of seizures, which may cause further damage.
What does Postictal mean?
The postictal state is a period that begins when a seizure subsides and ends when the patient returns to baseline. It typically lasts between 5 and 30 minutes and is characterized by disorienting symptoms such as confusion, drowsiness, hypertension, headache, nausea, etc.
What is status epilepticus?
Abstract. Status epilepticus is a neurological emergency that is commonly encountered by the neurohospitalist. Successful treatment depends upon the recognition of prolonged seizure activity and the acute mobilization of available resources.
How many people develop epilepsy after SE?
The consequences of SE alone, however, can be significant. The primary concern is that epilepsy will develop in about 20% to 40% of patients after a single episode of SE. In addition, prolonged seizure activity has profound neuropsychological consequences.
What should a neurohospitalist do before adding a second or third agent?
The neurohospitalist should maximize the dosing of a single drug to high therapeutic or supratherapeutic drug levels before adding a second or third agent. Standardized protocols for anticonvulsant medications have been shown to decrease the time needed to control seizure activity.25.
What is the treatment for refractory epilepticus?
Treatment of refractory status epilepticus (RSE) requires anesthetic doses of anticonvulsant medication. Early administration of these medications may allow for more successful treatment of very recalcitrant forms of status epilepticus. Significant questions remain as to the depth and duration of treatment for RSE.
What benzodiazepines are used for SE?
The 3 benzodiazepines used in the treatment of SE are diazepam, lorazepam, and midazolam.
Is diazepam a lipid soluble drug?
It is, however, highly lipid soluble, leading to rapid redistribution and decreases in brain concentrations. Clinical effectiveness is only about 20 minutes. Relapse rate is high and thus a second drug is required if diazepam is used as a first-line drug.27Diazepam can be given rectally in gel form and intramuscularly.
Is EEG monitoring available in NCSE?
The availability of EEG monitoring is often a problem. When EEG monitoring is not available and there are concerns that a patient may be in NCSE, it may be prudent to place the patient under a short-acting anesthetic (ie, propofol, thiopental) until monitoring can be arranged and the sedative medications discontinued.
What is the treatment for epilepsy?
Medications commonly used in the treatment of epilepsy include: Phenobarbital.
What is the phase of a seizure in which the patient has extreme muscular rigidity with hyperextension of
The phase of a seizure in which the patient has extreme muscular rigidity with hyperextension of the back is known as the: Hypertonic phase . The patient with a history of seizures may experience an unusual sensation that precedes a seizure episode by a period of time. This sensation is known as a/an:
Is a patent seizure normal?
You are treating a known epileptic, who is in her second trimester of pregnancy, for a generalized seizure. Your patent's seizure is normal for her condition, and on your arrival, she is postictal, regaining consciousness, and reluctant to be transported.
Can a complex partial seizure be mistaken for a (n)?
Simple partial. It is important that the EMT recognize that a complex partial (psychomotor) seizure can easily be mistaken for a (n): Alcohol intoxication. A female patient with a history of seizures has suffered a seizure in a public area and is now refusing further assessment and transport.
differentiation from pseudoseizure
pseudoseizure (technical terminology varies including “Paroxysmal Non-Epileptic Seizures” or “psychogenic, non-epileptic attacks”)
causes
Many factors often combine to lower the patient's seizure threshold, leading to status epilepticus. Ideally, all such factors will be addressed, reducing the likelihood of recurrence.
investigation
Careful review of medication list, focusing on any recent changes (look up drugs individually to determine if they lower seizure threshold, or if they participate in drug-drug interactions with other medications that affect seizure threshold).
initial treatment
This algorithm describes the approach to a convulsive generalized seizure lasting >5 minutes. For a patient with recurrent seizures who isn't actively seizing, a more gradual approach may be taken (with escalation if an active seizure re-emerges).
benzodiazepine is front-line therapy
Most seizures are self-limited. Often this will involve a tonic phase, followed by a clonic phase, and finally a post-ictal phase. If the patient is still in a tonic phase after three minutes, it is unlikely that their seizure will break spontaneously.
hypoglycemia, hyponatremia, and thiamine deficiency
Hypoglycemia must be excluded in any patient with seizures or mental status changes.
conventional antiepileptic
Any patient who seizes for >5 minutes should receive an antiepileptic agent, even if benzodiazepine is successful in stopping the seizure. The benzodiazepine will last only for a few hours, so treatment with benzodiazepine alone leaves the patient at risk for delayed seizure recurrence.