Status epilepticus is defined as a medical emergency that necessitates prompt attention. A seizure is an erratic, disorganized electrical activity that arises inside the brain. If an individual experiences recurrent seizure, a diagnosis of epilepsy is given based on the blood tests, medical history and other tests such as spinal tap, EEG or imaging studies.
Close look on status epilepticus
Once status epilepticus occurs, an individual with epilepsy has an impaired level of consciousness along with continuous or repetitive seizures. A normal seizure only lasts for a few minutes. Nevertheless, if a seizure lasts 5-30 minutes without gaining consciousness, the individual is diagnosed with status epilepticus.
Remember that the condition can be deadly if not promptly treated. The complications that might arise include dysfunction of the lungs or heart, rise in the body temperature, metabolic changes and irreversible brain damage.
What are the causes?
Status epilepticus can affect individuals of all ages, but certain factors increases the risk among children.
Some of the precipitating factors include:
- Head injuries
- Febrile disease
- Systemic infections
- Certain types of cancer
- Abrupt withdrawal from alcohol or prohibited drugs
- Abrupt withdrawal from anticonvulsants
- Metabolic conditions
- Low level of antiepileptic drug in the bloodstream
Management of status epilepticus
The primary treatment starts by following the ABC rules:
- Airway is clear
- Breathing is present
- Restoring the bodily fluids
A medical assessment is also carried out to determine why the individual went into a state of status epilepticus in the first place.
Since controlling the seizures is an objective of treatment, medications are usually given.
- The initial and preferred choice are intravenous benzodiazepines such as lorazepam, diazepam and midazolam. If not effective, one of these medications might be repeated, but if it is fails to work after the 2nd dose, switching to a different drug is an option.
- For the drugs given on the second therapy approach, it includes intravenous fosphenytoin, levetiracetam or valproic acid. If one does not work, another is used, or phenobarbital can be given. In case the second approach does not work, the aggressive phase is started which involves continuous EEG monitoring. The second therapy medications might be repeated, or the individual is treated with an anesthetic dose of midazolam, thiopental, Propofol or pentobarbital.