Status epilepticus

Definition

Seizure lasting >= 5 min
Treat a 'prolonged seizure' = "any convulsive seizure that continues for more than 2 minutes longer than a person's usual seizure" as status

useful initial investigations

  • Routine bloods including Mg, Ca, Phos + VBG (glucose!)

treatment

  • 1st line: IV lorazepam 4mg IV (or 10mg IV diazepam, or 10mg buccal midazolam)
    • 2nd dose can be given in 5-10 mins if no response
  • 2nd line:
    • levetiracetam 60mg/kg, max 4500mg
      • 100ml of NaCl/5% glucose over 10 minutes
    • phenytoin 20mg/kg
      • administer in 50-250ml of 0.9% sodium chloride (concentration not to exceed 10mg/ml) at a rate not exceeding 50mg/minute
    • valproate IV 40mg/kg
      • administer in 50ml of 0.9% sodium chloride or 5% glucose over 10 minutes.
      • first choice where eGFR <30
  • 3rd line: consider general anaesthesia

pitfalls

  • seizure mimics: hypoglycaemia, ...
  • Usually multiple factors lowering seizure threshold
    • Medication interactions e.g. antipyschotics, LAs, antibiotics...

as the dust settles

  • CT Head +/- angio vs venogram
  • Lumbar puncture

#neurology #incomplete

Paediatric seizures

https://www.nice.org.uk/guidance/ng217/chapter/7-Treating-status-epilepticus-repeated-or-cluster-seizures-and-prolonged-seizures
https://emcrit.org/ibcc/sz