Status epilepticus

INTRODUCTION:
  • Staus Epilepticus refer to continuous seizures or reparative, discrete seizures with impaired consciousness in the interictal period
  • Seizure activity not resolving spontaneously , or recurrent seizures with no recovery of consciousness in between
ETIOLOGY:
  • Acute symptomatic, remote symptomatic & idiopathic causes
  • Anticonvulsant withdrawal or non-compliance -GCSE
  1. Common etiology:
  2. H/O previous CNS insult
  3. Infection- meningitis & encephalitis
  4. Metabolic derangement
  5. Hypoglycemia , Hyponatremia
  6. Neoplasia or Tumor
  7. Drug toxicity
  8. Acute stroke
  9. Alcohol intake
  10. Anoxia/Hypoxia
  11. Infection with fever(meningitis) is the most common cause in children
CLINICAL FEATURES:
  • Prolonged rigidity &/or clonic movements with loss of awareness
  • As seizures activity becomes prolonged, movements may become more subtle- Mild clonic movements of only the fingers & fine rapid movements of eyes There may be proxysmal episodes of tachycardia, hypertension & pupillary dilation
  • Cynosis, pyrexia, acidosis & sweating may occur
COMPLICATIONS:
  • Aspiration
  • Hypotension
  • Cardiac Arrythmias
  • Renal Failure
  • Hepatic Failure
  • Epilepsy
  • Encephalopathy
  • Focal neurological deficit
MANAGEMENT:
  • OPIOIDS
  • Morphine acts by agonistic activity on ╬╝, K and ╬┤ receptors.
  • The drug of choice for status epilepticus is Lorazepam
  • In status epilepticus, drug of choice is IV diazepam
  • Receptor for opioid system - G protein-coupled orphanin opioid-receptor-like subtype1 (ORL1).
  • A child in status epilepticus should be given Clonazepam, Phosphenytoin & Diazepam
  • Its endogenous ligands are nociceptin /orphanin FQ (N/OFQ System).
  • Nociceptin: similar to dynorphin but acts only at the ORL1 receptor.
Opioids Natural opioids Morphine, Codeine
Semisynthetic opioids Diacetyl morphine (Heroin), Pholcodeine
Synthetic opioid Pethidine(Meperidine), Fentanyl, Methadone, Dextropropoxyphene, Tramado
Complex Agonist- antagonist Nalorphine, Pentazocine, Dezocine, Meptazinol, Butorphanol
Action opioid & antagonists Partial/weak ╬╝agonist + K antagonist Buprenorphine
Pure antagonists Naloxone, Naltrexone, Nalmefene
Exam Question
  • The initial drug of choice for status epilepticus is Lorazepam
  • Causes of status epilepticus in a child Hyponatremia
  • Status epilepticus is the complication (s) of meningitis in a child
  • A child in status epilepticus should be given Clonazepam, Phosphenytoin & Diazepam
  • In status epilepticus, drug of choice is IV diazepam
Don't Forget to Solve all the previous Year Question asked on Status epilepticus