Status Epilepticus, Definition, and its Management
- 1. TOPIC : STATUS EPILEPTICUS Name : SNEHASIS ADHIKARY Student Code : BWU/BPA/23/018 Programme Name : B.Sc. In Physician Assistant Semester / Year : 4th Sem – 2nd Year Department Name : Department of Allied Health Sciences Course Name : Pediatrics & Geriatrics Course Code : BPAC402 Roll Number : 23010313017 Registration Number : 23013000477 of 2023-2024
- 2. STATUS EPILEPTICUS Status epilepticus is a neurological emergency associated with high mortality and long term disability. Adverse consequences can include hypoxia, hypotension, acidosis and hyperthermia. The recommended sequential protocol for treatment with benzodiazepines, phenytoin and barbiturates. The goal is to stop the seizures as soon as possible.
- 3. EPIDEMIOLOGY The annual incidences of Status Epilepticus (SE) in children is reported as 10 to 73 episodes /100,000 children and is highest in children younger than two years of age. Mortality has been reported to be between 2.7% and 8% with an overall morbidity of between 10% and 20%
- 4. DEFINITION Status Epilepticus was defined as continuous seizure activity or recurrent seizure lasting longer than 5 minutes or a series of seizures without a return to baseline level of alertness between the seizures.
- 5. STATUS EPILEPTICUS:BASED ON TIMING SE may be categorized based on etiology, seizure type or timing… Attention to the timing stage of SE ensures management proceeds without delay In the initial 5 minutes of seizures, a period referred to as the prodromal stage , it is unknown whether the seizure will self- terminate or evolve into Status Epilepticus. Persisting Status Epilepticus may be divided into – Early SE ‘impending’ (5-30 min.) Established SE (30 min.) Refractory SE (RSE) : seizures that persist despite treatment with adequate doses of an initial 2 or 3 anticonvulsant medications).
- 6. PATHOPHYSIOLOGY Status Epilepticus results from a combination of persistent cellular excitation and a failure of centrally mediated mechanisms to suppress sustained seizure activity Generalized SE is also associated with several systemic physiologic changes as a result of a massive release of catecholamines. Early manifestations (during the first 30 min. of SE) include Cardiac arrhythmia Hyperglycemia Hypertension Lactic Acidosis Tachycardia Just beyond 30 min. blood pressure and glucose concentration may begin to normalize, or even reverse in abnormality.
- 7. Prolonged SE (beyond 60 min.) may be associated with : Hypothermia Hypoglycemia Hypotension Pulmonary edema Renal Failure Rhabdomylosis Cerebral ischaemia from hypoperfusion
- 8. STATUS EPILEPTICUS : THE OBJECTIVE OF ACUTE MANAGEMENT 1. Maintenance of adequate Airway, Breathing and Circulation (ABCs). 2. Termination of the seizure and prevention of recurrence. 3. Diagnosis and initial therapy of life-threatening causes of SE (eg. – Hypoglycemia, Meningitis and Cerebral space-occupying lesions). 4. Management of Refractory Status Epilepticus (RSE)
- 11. REFERENCE ALSG. Advanced Paediatric Life Support: The Practical Approach, Australia and New Zealand, 5th Edition. October 2012, BMJ Books. Novorol CL, Chin RFM, Scott RC. Outcome of convulsive status epilepticus: a review. Arch Dis Child 2007;92:948-51. Appleton R, Macleod S, Martland T. Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children. Cochrane Database of Systematic Reviews 2008(3). Leeann S, Pennington V, Acworth J, Thornton S, Ngo P, Mcintyre S, et al. Emergency Management of pediatric convulsive status epilepticus. Pediatric emergency care 2009;25(2):83-7. McMullan J, Sasson C, Pancioli A, Silbergleit R. Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: a meta-analysis. Acad Emerg Med. 2010 Jun;17(6):575-82 Guardrails paediatric guidelines – accessed 2 July 2014 at http://adhbintranet/medsafety/Guardrails.htm JN Friedman; Canadian Paediatric Society, Acute Care Committee. Emergency management of the paediatric patient with generalized convulsive status epilepticus. Paediatr Child Health 2011;16(2):91-7. Epilepsy Foundation. (2014). Status Epilepticus. Retrieved from: https://www.epilepsy.com/learn/challenges-epilepsy/seizure-emergencies/s... 1. Michelle Bischoff. (2010). PedsCases Podcast Status Epilepticus. Retrieved from: https://www.pedscases.com/status-epilepticus-children