Status epilepticus is a prolonged seizure, usually defined as >30 minutes.
Over half of patients presenting with status epilepticus do not have known epilepsy.
The main acute causes in adults are:
- stroke
- hypoxia
- metabolic derangement
- alcohol intoxication or withdraw
In children, the leading cause is infection.
Management:
- secure airway and resuscitate
- give oxygen
- anti-epileptics:
- pre-hospital: diazepam 10-20mg PR or midazolam 10mg buccally
- first line in hospital: lorazepam (or diazepam) IV
- terminates around 75-80% of seizures
- if benzo unsuccessful: phenytoin infusion 15-18mg/kg at a rate of 50mg/minute
- will terminate around 50% of resistant seizures
- if any suggestion of alcohol abuse or impaired nutrition give 50mls of 50% glucose and/or 250mg IV thiamine
- if status is refractory (ie not resolved 60-90 minutes after initial anti-epileptic) anaesthetise using propofol, midazolam or thiopental sodium.
Prognosis: mortality of 10-20% rising to nearly 50% in refractory status epilepticus.
