Status Epilepticus

Recurrent epileptic seizures without full recovery of consciousness

Aetiology

Precipitants of status

  • Severe metabolic disorders - hyponatraemia, pydidoxine deficiency
  • Infection
  • Head trauma
  • Sub-arachnoid haemorrhage
  • Abrupt withdrawal of anti-convulsants
  • Treating absence seizures with CBZ

Pathophysiology

Types

  • Generalised convulsive status epilepticus
    • Generalised convulsions without cessation
    • Excess cerebral energy demand and poor subtrate delivery causes lasting damage - glutamate release, excitotoxicity, neuronal death
    • Can cause: respiratory insufficiency and hypoxia, hypotension, hyperthermia, rhabdomyolysis
  • Non-convulsive status - conscious but in 'altered state'
  • Epilepsia partialis continua - continual focal seizures, consciousness preserved
    • The possibility of partial status epilepticus should be considered in any patient presenting with an acute confusional state
    • Confirm diagnosis with EEG recording
    • Drug treatment and investigation as for convulsive status short of general anaethesia and ITU admission
    • Seek specialist advice in refractory cases

Clinical presentation

  • Continuous seizure activity lasting more than 30 mins

Investigations

  • Identify cause after stabilising patient - emergency blood tests +/- CT

Management

  • ABCDE approach
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  • Give glucose if any suggestion of hypoglycaemia
  • Give IV thiamine if any suggestion of alcoholism or impaired nutritional status