Status Epilepticus
- Life-threatening state in cases with 3 consecutive seizures without regaining consciousness between them or in cases with continuous epileptic activity lasting for more than 5-10 min.
- SE is most frequent in age < 5 years and > 65 years.
- Causes:
- Treatment mistakes, sudden AEDs termination, concomitant diseases, poor compliance
- Acute symptomatic (in cases with acute stroke, anoxia, cranial trauma, neuroinfections, metabolic imbalance, alcohol abstinence, tumor, drug intoxication).
Pathogenesis
- 1st phase (up to 20th min.) – increased brain metabolism and blood supply, sympathetic activation with cardio-circulatory abnormalities.
- 2nd phase (after 20th min.) – compensatory mechanisms are switched off and the brain blood supply depends on the systemic BP. The result is hypoxia and increased oxygen consumption. The systemic hypotonia and increase intracranial pressure leads to brain edema and neuronal death.
- Complications from the internal organs – pulmonary edema, cardio-circulatory, hepatic, renal, respiratory insufficiency.
Classification
- Generalized convulsive SE
- Generalized tonic-clonic
- Generalized tonic
- Generalized clonic
- Generalized myoclonic
- Hemicorporal – < 3 years
- Generalized non-convulsive SE
- Picnolepsy
- Obnubilation
- Confusion state
- Lethargic state
- Partial SE
- Simple
- Complex
- Epilepsia partialis continua of Kojevnikov
- Suspected viral or autoimmune pathogenesis
- Clonic or tonic jerks limited in a part of the extremity, the whole extremity or the body half, associated with motor deficit.
- Pathohistology, CT scan, МRТ – unilateral brain atrophy.
Refractory SE
Super-refractory SE
Treatment
- On the spot of SE
- Conducting airways ensurance
- Tongue protection by a soft object between teeth
- Prevention of vomited substance aspiration – the head is turned to one side
- Trauma prevention
- Mouth cleaning
- Tight clothes elimination
- Brief physical and neurological examination
- Eventual intubation
- Applied AEDs registration
- Venous way ensuring
- Hospitalization in an intensive care unit
- AEDs – Diazepam 10 mg i.v. or i.m. and/or Phenobarbital 200 mg i.m.
- In an intensive care unit
- Oxygen supply
- Permanent venous way ensuring
- ECG, respiration, cardiac activity monitoring
- Physical and neurological examination
- Laboratory investigations, serum drug level examination
- AEDs for SE management:
- Diazepam amp. 10 mg – i.m., i.v. slow infusion. An important adverse event is respiratory depression. No more than 3-4 amp.
- Depakine fl. 400mg/4ml – 15 mg/kg, followed by venous infusion 1 mg/kg/h.
- Mannitol 10% 500ml i.v. (anti-edema effect).
- Maintenance of water-electrolyte and acid base balance.
- In cases with no SE management - Thiopental 3-5mg/kg i.v