Status epilepticus

      Status epilepticus (SE) is defined as continuous seizure activity or multiple seizures without full recovery of consciousness in between. SE is a neurological emergency in which prolonged seizures can cause permanent brain injury and place patients at which for systemic cardiopulmonary complications. Although various lengths of continuous seizures have been used previously to denote SE, an operational definition of 5 minutes is now recommended as seizures that continue beyond this time are unlikely to terminate on their own. Management principles for status epilepticus focus on early emergency administration of anticonvulsants while ensuring attention to the basic ABC medical principles of Airway, Breathing, and Circulation. Initial first-line treatment should be with rapid-acting benzodiazepines and recent research done in the pre-hospital setting suggests that this should be with intramuscular midazolam or, if an intravenous (IV) line is present, IV lorazepam. For seizures that continue despite an adequate dose of benzodiazepines, second-line treatment is most often with phenytoin/fosphenytoin. However, optimal second-line treatment is not clear and a current randomized clinical trial is testing fosphenytoin, levetiracetam, and valproic acid. For seizures that continue beyond this, treatment usually consists of intubation and instituting an anesthetic infusion of benzodiazepines, barbiturates, or propofol in conjunction with continuous monitoring via electroencephalography. However, the relative efficacy of these interventions have been less studied. This talk will focus on emergency management of status epilepticus, its causes and workup, and options for super-refractory SE cases.
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