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  Status epilepticus

Status epilepticus (SE) is a condition in which the brain is in a constant state of seizure. This disease is extremely dangerous and life threatening. Usually status epilepticus is identified as one long seizure or continuous seizures without regaining consciousness for more than thirty minutes. Doctors primarily agree that a seizure that lasts five minutes is enough to damage neurons and usually will not end without intervention.

Status epilepticus Neurological disorder
Status epilepticus


Symptoms

Classification for status epilepticus varies throughout medical literature. Mainly there are two types generalized convulsive static epilepticus (GCSE) and non-convulsive status epilepticus (NCSE). All forms of epilepsy can develop into status epilepticus.

Generalized convulsive status epilepticus is prolonged convulsions with little consciousness. Patients with GCSE may stop having motor activity or have little motor activity but still register seizures on an electroencephalograph (EEG). Treatment is vital whether the patient continues to have motor activity or not.

Non-convulsive status epilepticus (NCSE) patients present with a number of symptoms such as, confusion and sleep walking, impaired or altered affect, coma, fugue states, abnormal autonomic symptoms, delusions, hallucinations, aphasia and paranoia. A fugue state is when a person forgets who they are, like amnesia. There are three categories of NCSE: generalized, focal or other. The general state in which a patient has unimpaired arousal but impaired attention is referred to as epileptic twilight state and represents a combination of generalized and focal NCSE. Prolonged focal seizures are a seizure in which only a part of the body is shaking and the patient is conscious is referred to as a simple partial status epilepticus.

Diagnosis

Diagnosis needs to be made as soon as possible to determine the cause or underlying conditions of status epilepticus.

There are a few things that need to be done immediately:

 A CBC, complete blood count with a serum chemistry profile and a drug screen
 Check for drug overdose or drug withdrawal, as not being compliant with epileptic medication can cause this condition
 Check arterial blood gas if respiratory distress is suspected
 Perform a brain scan with our without tracers to assess for lesions or tumor
 Evaluate a spinal tap (lumbar puncture) especially if infection is likely
 Perform an EEG if there is no response to intervention or an atypical presentation of symptoms

Treatment

Status epilepticus is treated with strong intravenous medications that have serious adverse side effects. Treatment includes maintaining oxygenation and good circulation. If the patient has had previous seizures, then it should be determined when and how much of medication has been recently taken by the patient. A saline infusion should be started and if hypoglycemia is present then glucose should be given to the patient. Hypoglycemia can cause status epilepticus and is quickly reversible. Thiamine needs to be given with the glucose to prevent Wernicke’s encephalopathy in patients at risk for this complication.

If the seizure persists after initial measures, then seizure medication should be given. Medications that are used for the treatment of status epilepticus are benzodiazepines, phenytoin and fosphenytoin, barbiturates, general anesthesia (artificial respiration needs to be applied to the patient as well) or lidocane.

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