INTRODUCTION

• STATUS EPILEPTICUS: Is an epileptic seizure of

greater than five minutes or more than one
seizure within five minutes period without the
person returning to normal between them.
• The seizures can either tonic-clonic type with
a regular pattern contraction and extension of
the arms and legs or the type that do not
involve contraction such as absence siezures
or complex partial seizures.
• Status epilepticus is a life- threatening medical
emergency particularly if tratment is delayed.
• S.E may occur in those with a history of
epilepsy as well as those with an underlying
problem of brain.
• The underlying brain problems include
trauma, infections, or stroke among others.
 EPIDEMIOLOGY
• In the united states, about 40 cases of SE
occur annually per 100,000 people.
• This includes about 10-20% of all firt
seizures.
 AETIOLOGY
• Head trauma: drug/alcohol abuse or
withdrawl.
• CNS tumour: congenital CNS abnormality.
• CVA fever, acute systemic or metabolic illness.
• CNS infection:AED noncompliance
idiopathic-15-30%
 PATHOPHYSIOLOGY
• SE is tought to result from failure of mechanism
that normally terminate an isolated seizure.
• Tgis failure can arise from abnormal persistence of
excessive excitation or ineffective recuirement of
inhibition.
• Experimental studies suggest that there is an
induction of reverberating siezure activity
between hippocampus and parahippocampal
structures and seizures progresses through a
sequence of distinct electrophysiological changes.
• The proposed mechanism of are as follows:
1.constant activation of hippocampus
2. loss of GABA- mediated inhibitory synaptic
transmission in hippocampus.
3.Glutaminergic excitatory synaptic
tranmission, important for sustaining SE.
 SIGNS AND SYMPTOMS
• A seizure that lats more than 5 minutes, or more
than one seizure in a row without regaining
conciousness in between.
• Muscle spasm.
• Falling.
• Unusual noises.
• Loss of bowel or bladder control.
• Irregular breathing.
• Unusual behavior.
• Difficulty speaking.
 TREATMENT
• Benzodiazepines are the preferred initial treatment
after which typically phenytoin is given.
• Benzodiazepines.
• When given intravenously, lorazepam appears to be
superior to diazepam for stopping seizure
activity. Intramuscular midazolam appears to be a
reasonable option especially in those who are not in
hospital.
• The benzodiazepine of choice in North America for
initial treatment is lorazepam due to its relatively long
duration of action (2–8 hours) when injected, and its
rapid onset of action, which is thought to be due to its
high affinity for GABA receptors and to its
low lipid solubiliy, which causes it to remain in
the vascular compartment.
• If lorazepam is not available, or intravenous access is not
possible, then diazepam should be given. In several
countries outside North America, intravenous
clonazepam is regarded as the drug of first choice. For
instance a guideline from the Netherlands recommends
clonazepam. Cited advantages of clonazepam include a
longer duration of action than diazepam and a lower
propensity for the development of acute tolerance than
lorazepam. The use of clonazepam for this indication has
not caught on in North America, as it is not available as
an intravenous formulation there.
• Phenytoin and fosphenytoin.
• Phenytoin was once another first-line
therapy, although the prodrug fosphenytoin can be
administered three times as fast and with far fewer
injection site reactions. If these or any
other hydantoin derivatives are used, then cardiac
monitoring is a must if they are administered
intravenously. Because the hydantoins take 15–30
minutes to work, a benzodiazepine or barbiturate is
often coadministered. Because of diazepam's short
duration of action, they were often administered
together anyway.
• Carbamazepine and valproate.
• Valproate is available to be given intravenously, and may be used
for status epilepticus. Carbamazepine is not available in an
intravenous formulation, and does not play a role in status
epilepticus.
• Barbiturates.
• Before the benzodiazepines were invented, there were the
barbiturates, which are still used today if benzodiazepines or the
hydantoins are not an option. These are used to induce
a barbituric coma. The barbiturate most commonly used for this
isphenobarbital. Thiopental or pentobarbital may also be used
for that purpose if the seizures have to be stopped immediately
or if the person has already been compromised by the
underlying illness or toxic/metabolic-induced seizures; however,
in those situations, thiopental is the agent of choice.
 REFRENCES
1. Al-Mufti, F; Claassen, J (Oct 2014). "Neurocritical Care: Status
Epilepticus Review.". Critical Care Clinics 30 (4): 751–
764. doi:10.1016/j.ccc.2014.06.006.PMID25257739.
2. Trinka, E; Höfler, J; Zerbs, A (September 2012). "Causes of status
epilepticus.". Epilepsia. 53 Suppl 4: 127–38. doi:10.1111/j.1528-
1167.2012.03622.x.PMID22946730.
3. Prasad, M; Krishnan, PR; Sequeira, R; Al-Roomi, K (Sep 10, 2014).
"Anticonvulsant therapy for status epilepticus.". The Cochrane
database of systematic reviews9:
CD003723. doi:10.1002/14651858.CD003723.pub3.PMID2507925.
4. Wijdicks, Eelco F. M.; Parisi, J. E.; Sharbrough, F. W. (February 1994).
"Prognostic value of myoclonus status in comatose survivors of
cardiac arrest". Annals of Neurology35 (2):
239–43. doi:10.1002/ana.410350219.PMID 8109907.