Status Epilepticus

Presentation

Figure 1 : Epilepsy

Source  - nethealthbook.com

Common symptoms include:

• Focal or unilateral paresthesias or numbness
• Focal visual changes, usually characterized by flashing lights
• Focal visual obscuration or focal colorful hallucinations
• Olfactory or gustatory hallucinations
• Atypical rising abdominal sensations

Epilepsy partialis continua, or focal status epilepticus of the motor cortex, may occur in various contexts. It is subdivided into type I (nonprogressive) and type II (progressive) epilepsy.

Type I complex partial status epilepticus refers to recurrent, recognizable complex partial seizures without recovery between seizures.

Symptoms of type I epilepsy partialis continua:

• Intermittent, semi-rhythmic, involuntary twitching involving a discrete subset of muscles
• Most commonly affects the face and ipsilateral distal hand musculature
• Myoclonus of this variety may evolve into partial or generalized convulsion

Type II represents continuous, ongoing complex partial seizure activity.

Symptoms of type II epilepsy partialis continua:

• Usually linked with Rasmussen encephalitis
• Gradual loss of unilateral function, with parallel focal or unilateral hemispheric atrophy
• Impaired intellectual skills to various degrees
• Possible effect on language skills

(Roth J. L., Blum A. S. & Berman S. A. 2014)

Causes

• The major cause of status epilepticus in children is infection with fever.
• In adults, the most common risk factors for status epilepticus are stroke, hypoxia (oxygen deprivation), metabolic disorders, and alcohol intoxication.
• Some drugs and medications such as penicillin, antihistamines and antidepressants also may trigger the extended seizures.

(Florida Hospital)

Investigations

• Glucose and electrolyte levels (including calcium, magnesium)
• Complete blood count
• Renal and liver function tests
• Toxicologic screening and anticonvulsant drug levels
• Arterial blood gas results

Other tests that may be appropriate depending on the clinical setting include the following:

• Electroencephalography
• Blood cultures
• Urinalysis and/or cerebrospinal fluid analysis
• CT scanning and/or MRI of the brain
• Chest radiography

(Roth J. L., Blum A. S. & Berman S. A. 2014)

Stepwise Management

Pharmacotherapy

• Most patients with status epilepticus who are treated aggressively with a benzodiazepine, fosphenytoin, and/or phenobarbital experience complete cessation of their seizures. If status epilepticus does not stop, general anesthesia is indicated.
• Medications used in the treatment of status epilepticus include the following:
• Benzodiazepines (eg, lorazepam, diazepam, midazolam): First-line agents
• Anticonvulsant agents (eg, phenytoin, fosphenytoin)
• Barbiturates (eg, phenobarbital, pentobarbital)
• Anesthetics (eg, propofol)

Supportive therapy

Supportive care in patients with status epilepticus includes the following:

-       Maintenance of vital signs

-       Airway, breathing, circulation (eg, hemodynamic/cardiac monitoring)

-       Respiratory support, with intubation and/or mechanical ventilation if necessary

-       Periodic neurologic assessments

Surgery

Surgical intervention for status epilepticus is a last resort and rarely performed.

(Roth J. L., Blum A. S. & Berman S. A. 2014)

REFERENCES

Roth J. L., Blum A. S. & Berman S. A. 2014. Medscape. [ONLINE] Available at: 
http://emedicine.medscape.com/article/1164462-overview [Accessed 27th April 15]

Florida Hospital. (nd.) Florida Hospital. [ONLINE] Available at: 
https://www.floridahospital.com/status-epilepticus/causes  [Accessed 27^th April 15].