Book contents
- Seizure and Epilepsy Care
- Seizure and Epilepsy Care
- Copyright page
- Contents
- 1 How Do I Evaluate a First-Time Seizure?
- 2 How Do I Make an Epilepsy Diagnosis?
- 3 Which Antiseizure Medicines Treat Epilepsy and How Do I Pick?
- 4 How Can I Best Use EEG for Treating Epilepsy Patients?
- 5 What Are Common Epilepsy Imaging Findings in New Onset and Chronic Epilepsy Care?
- 6 How Do I Care for Patients in the Emergency Department and Inpatient Settings?
- 7 How Do I Manage Epilepsy Emergencies Like Status Epilepticus?
- 8 What Is the Best Long-Term Treatment Plan for Epilepsy Patients as an Outpatient?
- 9 What to Do When Your Patient Fails Two Antiseizure Medicines
- 10 Nonepileptic Events and General Psychiatric Care for Epilepsy Patients
- 11 What Are Essential Pediatric Epilepsy Clinical Diagnoses and Treatment Plans?
- Index
- References
7 - How Do I Manage Epilepsy Emergencies Like Status Epilepticus?
Published online by Cambridge University Press: 28 January 2023
Book contents
- Seizure and Epilepsy Care
- Seizure and Epilepsy Care
- Copyright page
- Contents
- 1 How Do I Evaluate a First-Time Seizure?
- 2 How Do I Make an Epilepsy Diagnosis?
- 3 Which Antiseizure Medicines Treat Epilepsy and How Do I Pick?
- 4 How Can I Best Use EEG for Treating Epilepsy Patients?
- 5 What Are Common Epilepsy Imaging Findings in New Onset and Chronic Epilepsy Care?
- 6 How Do I Care for Patients in the Emergency Department and Inpatient Settings?
- 7 How Do I Manage Epilepsy Emergencies Like Status Epilepticus?
- 8 What Is the Best Long-Term Treatment Plan for Epilepsy Patients as an Outpatient?
- 9 What to Do When Your Patient Fails Two Antiseizure Medicines
- 10 Nonepileptic Events and General Psychiatric Care for Epilepsy Patients
- 11 What Are Essential Pediatric Epilepsy Clinical Diagnoses and Treatment Plans?
- Index
- References
Summary
Status epilepticus (SE) is a neurological emergency defined as a continuous seizure or cluster of seizures lasting longer than 30 minutes. Because of increased mortality risk, SE is practically defined at 5 minutes. Clinically, SE can be separated into convulsive SE (CSE) or nonconvulsive SE (NCSE). For both diagnoses, the initial treatment of choice is a benzodiazepine, most commonly lorazepam 4 mg IV. Midazolam and diazepam (to a lesser extent) are also appropriate. If the status epilepticus continues, loading doses of fosphenytoin (20 mg/kg), levetiracetam (60 mg/kg), or valproate (40 mg/kg) are the next step in management. Continuation of SE past this point is considered refractory. For CSE, patients are almost always intubated and managed with IV anesthesia. For NCSE, intubation is often not needed at this point, with additional ASMs used instead to sidestep the risk associated with intubation and IV anesthesia. A key factor in guiding SE management is identifying the etiology (i.e., antibiotics for meningitis).Lastly, post cardiac arrest is briefly discussed as it is unfortunately commonly encountered.
Keywords
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- Information
- Seizure and Epilepsy CareThe Pocket Epileptologist, pp. 129 - 138Publisher: Cambridge University PressPrint publication year: 2023
References
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