Status Epilepticus

Question 1

What is status epilepticus?

Answer 1

• A single seizure lasting more than 5 minutes

OR

• 2 or more within 5 minutes without return to normal in between

Question 2

How was status epilepticus previously defined?

Answer 2

Over a period of 30 minutes

Question 3

What are the two categories of status epilepticus?

Answer 3

• Convulsive

- Non-convulsive

Question 4

What are the two types of non-convulsive status epilepticus?

Answer 4

• Prolonged complex partial seizures

- Absence seizures

Question 5

What percentage of cases of status epilepticus are non-convulsive?

Answer 5

Up to 25%

Question 6

What percentage of people who have seizures or status epilepticus have epilepsy?

Answer 6

25%

Question 7

What are some other possible causes of status epilepticus or status epilepticus like-presentation (besides epilepsy)?

Answer 7

• Stroke
• Haemorrhage
• Intoxicants or adverse drug reactions
• Problems with anticonvulsants

Question 8

What problems with anticonvulsants can lead to seizures or status epilepticus?

Answer 8

• Insufficient dosage
• Sudden withdrawal
• Alcohol consumption or withdrawal
• Starting a new medication that affects anticonvulsant
• Developed resistance
• Gastroenteritis

Question 9

What are the risk factors for status epilepticus?

Answer 9

• <5 years or elderly
• Genetic predisposition
• Intellectual disability
• Structural brain pathology

Question 10

How doe convulsive status epilepticus present?

Answer 10

A regular pattern of contraction and extension of the arms and legs

Question 11

How does non-convulsive status epilepticus present?

Answer 11

A long duration change in a person’s level of consciousness without large scale bending and extension of limbs

Question 12

What investigations should be performed after an episode of acute status epilepticus to try and determine an underlying cause?

Answer 12

• Anticonvulsant drug blood levels
• Toxicology screen
• Comprehensive metabolic panel
• FBC

Question 13

What are the differentials for status epilepticus?

Answer 13

• Psychogenic non-epileptic SE
• Delirium
• Coma

Question 14

What are the initial management steps for status epilepticus?

Answer 14

• Secure airway
• Give high flow O₂
• Gain IV access

Question 15

What may be used to secure airway in status epilepticus?

Answer 15

Adjuncts

Question 16

What should IV access be used for in management of status epilepticus?

Answer 16

1) . Bolus of Lorazepam

2) . Bloods

Question 17

What dose of lorazepam is used initially in status epilepticus?

Answer 17

4mg

Question 18

What bloods can be taken in acute status epilepticus?

Answer 18

• U&E
• LFT
• FBC
• Glucose
• Calcium
• Toxicology screen
• Anticonvulsant levels

Question 19

How many times can lorazepam be given in status epilepticus?

Answer 19

No more than twice

Question 20

When should a second dose of lorazepam be considered in status epilepticus?

Answer 20

If no response 10-20 minutes after the first

Question 21

What can be used instead of lorazepam in status epilepticus if immediate IV access is not possible?

Answer 21

Buccal midazolam

Question 22

If seizures continue after 2 doses of lorazepam what can be used in status epilepticus?

Answer 22

IV phenytoin 10mg/kg (max1g) at no more than 100mg/minute

Question 23

What can be given after initial IV phenytoin dose in status epilepticus?

Answer 23

Maintenance 100mg phenytoin/6-8 hours

Question 24

What should be monitored during treatment of status epilepticus with phenytoin?

Answer 24

• Blood drug levels
• ECG
• BP

Question 25

For how long can a patient be treated for status epilepticus before anaesthetist is required?

Answer 25

20 minutes

Question 26

If a seizures goes on after 60 minutes despite initial lorazepam and phenytoin what may be needed?

Answer 26

Anaesthetic intervention to paralyse with propofol and ventilate with continuous EEG in ICU

Question 27

What treatment is available for status epilepticus caused by alcoholism?

Answer 27

Thiamine 250mg IV over 30 mins

Question 28

If glucose levels are abnormally low in status epilepticus what can be given?

Answer 28

Glucose 50ml 50% IV

Question 29

What other physiological parameters may need addressing in status epilepticus?

Answer 29

- Acidosis | - Hypotension

Question 30

What percentage of status epilepticus patients die within 30 days?

Answer 30

10-30%

Question 31

What do the people who die within 30 days of status epilepticus tend to have?

Answer 31

Underlying brain condition causing seizures e.g. tumour or stroke

Question 32

What are the acute complications of status epilepticus?

Answer 32

- Hyperthermia - Pulmonary oedema - Cardiac arrhythmias - Cardiovascular collapse

Question 33

What are the long term complications of status epilepticus?

Answer 33

- Epilepsy - Encephalopathy - Focal neurological deficits