Epilepsy
|
|
|
Status epilepticus |
|
|
EPILEPSY
Status epilepticus
Status epilepticus refers to continuous
seizures or repetitive, discrete seizures with impaired consciousness in
the interictal period. The duration of seizure activity sufficient to
meet the definition of status epilepticus has traditionally been
specified as 15 to 30 min. However, a more practical definition is to
consider status epilepticus as a situation in which the duration of
seizures prompts the acute use of anticonvulsant therapy, typically when
seizures last beyond 5 min.
Status epilepticus is an emergency and must be treated immediately,
since cardiorespiratory dysfunction, hyperthermia, and metabolic
derangements can develop as a consequence of prolonged seizures, and
these can lead to irreversible neuronal injury. Furthermore, CNS injury
can occur even when the patient is paralyzed with neuromuscular blockade
but continues to have electrographic seizures. The most common causes of
status epilepticus are anticonvulsant withdrawal or noncompliance,
metabolic disturbances, drug toxicity, CNS infection, CNS tumors,
refractory epilepsy, and head trauma.
Generalized status epilepticus is obvious when the patient is having
overt convulsions. However, after 30 to 45 min of uninterrupted
seizures, the signs may become increasingly subtle. Patients may have
mild clonic movements of only the fingers, or fine, rapid movements of
the eyes. There may be paroxysmal episodes of tachycardia, hypertension,
and pupillary dilation. In such cases, the EEG may be the only method of
establishing the diagnosis. Thus, if the patient stops having overt
seizures, yet remains comatose, an EEG should be performed to rule out
ongoing status epilepticus.
The first step in the management of a patient in status epilepticus is
to attend to any acute cardiorespiratory problems or hyperthermia,
perform a brief medical and neurologic examination, establish venous
access, and send samples for laboratory studies to identify metabolic
abnormalities. Anticonvulsant therapy should then begin without delay
[PakMed Homepage] [Disclaimer/Privacy Policy] [Contact]
© Copyrights PakMed Biomedical Solutions
Optimized for Java-script enabled Microsoft Internet Explorer 6, at screen resolution of 800 by 600 pixels.