Status Epilepticus: Clinical Features, Pathophysiology, and Treatment

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Status Epilepticus: Clinical Features, Pathophysiology, and Treatment Craig Watson, M.D., Ph.D. Professor of Neurology Wayne State University School of Medicine Director, WSU/DMC Comprehensive Epilepsy Program

Treatment of Status Epilepticus Time Frame Procedure 0-5 min Obtain vital signs, establish airway, administer oxygen if needed. Observe seizures briefly to ascertain that patient is really in status. Draw baseline blood work (CBC, chemistry panel, antiepileptic drug levels), draw ABGs (for pO2 and pH), draw toxicology screen. Quickly assess patient for signs of cardiorespiratory compromise, hyperpyrexia, focal neurologic signs, head trauma, CNS infection.

Treatment of Status Epilepticus Time Frame Procedure 6-9 min Start IV infusion with saline solution. Administer 100 mg thiamine, IV. Administer 50 ml of 50% glucose solution, IV, if blood sugar is low or unobtainable. Do not give glucose if blood sugar is normal or high. Always have CPR equipment at bedside of a patient in status.

Treatment of Status Epilepticus Time Frame Procedure 10-45 min Infuse lorazepam (Ativan), 0.1 mg/kg, at 2 mg/min. Begin IV loading dose of fosphenytoin (Cerebyx), 20 mg PE/kg, at 150 mg/min. Monitor patient’s B/P, pulse, EKG, and respirations while giving IV fosphenytoin and lorazepam. Side effects: hypotension, arrhythmia, paresthesias, and respiratory depression.

Treatment of Status Epilepticus Time Frame Procedure 46-60 min If seizures persist, intubate and give phenobarbital, 20 mg/kg, at 100 mg/min. Never use Valium and phenobarbital sequentially in the treatment of status, unless the patient is intubated and in an ICU. Their hypotensive and respiratory depressant actions synergize. Serious and abrupt side effects can occur with these two drugs when given together.

Treatment of Status Epilepticus Time Frame Procedure 1 hour If seizures persist, the patient should be placed in a drug induced coma with pentobarbital, a benzodiazepine, or other anesthetic agent to prevent life threatening lactic acidosis, hypoxia, hyperthermia, and permanent seizure-induced neuronal damage. The patient must be in an ICU, and outcome should be monitored and treatment guided by EEG with the goal being suppression of seizure activity on EEG.