STATUS EPILEPTICUS

1. Clinical diagnosis-
a) 2 fits occur without recovery of consciousness in between.
b) a single fit lasts longer than 30 minutes even without loss of consciousmess.
2. Fatal condition

CLASSIFICATION-
2 types mainly.
a. Generalised
b. Partial


a. Generalised further divided into convulsive & non convulsive.
b. Partial includes partial motor seizures.

CAUSES -
1. Sudden antiepileptic withdrawl
2. Metabolic disorders - hypoglycaemia,hypnatremia
3. Infections- encephalitis, meningitis
4. Brain tumor or trauma



TREATMENT
Control seizures first them underlying cause.


 step A
 ¤  first 20 min
 ¤ maintain airway
 ¤secure proper IV & draw blood for metabolic para
¤ briefe history
¤conduct rapid examination to determine focal signs, increased intrac tension.
¤administer diazepam 10 - 20 mi IV over 1-2 min & SOS every 10 min followed by loading dose of diphenyl hydantoin 18-20 mg per kg at a rate of 50 mg per min. Total ford should not exceed 1.000 mg this should control seizure in 20 min. If not then

STEP B-
¤20-60 MIN
¤phenobarbitol 20 mg per ki IV or diazepam infusion 2-4 mg per hr may require assisted ventilation. If not controled with this


STEP C

¤general anaesthesia for pentothal infusion
¤ simultaneously b.p,acidosis, ventilation & electrolyte balance
¤ago to control seizure within 1 hr after admission.


MANAGEMENT OF CONVULSIVE STATUS EPILEPTICUS

1) 0-5 min

 ¤maintain airway, breathing,& circulation
¤administer oxygen
¤insert iv line
¤obtain blood samples for glucose ,urea , electrolyte, bilirubin , toxicology
¤ administer glucose if hypoglycaemia

2) 5-20 min

¤administer diazepam
¤administer phenytoin
¤repeat diazepam
¤evaluate for intubation


3)20-60 min

¤administer phenobarbital
¤support of respiration
¤conduct detail examination

4) >60 min
¤ consider paraldehyde or lidocaine
¤intubate & ventilate
¤ administer general anaesthesia
¤ admit in ICU.