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Management of Status Epilepticus

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by

Abhishek Chitnis

on 20 May 2013

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Transcript of Management of Status Epilepticus

By Abhishek Chitnis Management of Status Epilepticus Definition Status Epilepticus (SE) is defined as a seizure lasting >30 minutes or repeated seizures without intervening consciousness
Aim to terminate seizures as soon as possible (<20min) as the risk of permanent brain damage will increase
SE usually occurs in known epileptics History Investigations FBC
U&E
Glucose
ABG
Ca2+
ECG Underlying Causes Infection: meningitis, encephalitis, abscess
Acute head injury
Cerebral tumour
Metabolic disorders: renal failure, hypoglycaemia hypercalcaemia
Drug overdose: tricyclics, phenothiazines, theophylline, isoniazid, cocaine
Acute cerebral infarction
Anoxic encephalopathy
Alcohol intoxication/withdrawal Management Algorithm Anticonvulsant levels
-> Carbamazepine, phenobarbital phenytoin
Toxicology screen
LP
Blood and urine culture
O2 saturation's Ask about:
Previous diagnosis of epilepsy
Previous history of status epilepticus
Recent withdrawal of anti-convulsant drug/missed medication
Respiratory tract or urinary tract infection
Vomiting/diarrhoea Lorazepam vs Diazepam Lorazepam is preferable to diazepam in the management of SE. Both drugs are equally rapidly acting and effective in controlling seizures, but lorazepam has a longer duration of anti-seizure action than diazepam (12-24 hours cf. 15-30 minutes).

However - if IV access difficult - PR diazepam

Buccal midazolam if PR not appropriate - children - squirt between lower gum and the cheek on each side and massage
The doctor is obliged to tell the patient to inform the DVLA – but the doctor does not have to directly inform the DVLA – UNLESS – after continued reminders to the patient, the patient continues to drive, the doctor then has a duty to break confidentiality to inform the DVLA.

Patients CANNOT drive if:
They have changed their medication in the last 6 months
They have had a seizure in the last 12 months
HOWEVER - If the patient has ‘night-time’ only seizures, they can drive, if they have not had a ‘day time’ seizure for the last 3 years. Note that a nocturnal seizure can occur in the day – it is just any seizure when the patient is asleep. Driving and epilepsy – the law in the UK
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