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Management of Status Epilepticus

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Acute Neuro Care

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Abstract

A 34-year-old male patient presented to casualty with tonic-clonic seizures. He was treated with two doses of 0.1 mg/kg of intravenous (IV) lorazepam with in 5 min apart with oxygen supplementation and airway support, in addition, Phenytoin 20 mg/kg IV was administered over 30 min. On examination, the patient was found unresponsive and continued to have seizures. The patient was intubated for airway protection, and IV Levetiracetam 30 mg/kg bolus was administered. The patient was put on mechanical ventilation, and he continued to have seizures. Intravenous anesthetic midazolam 0.2 mg/kg bolus was given followed by 0.2 mg/kg/h, titrated up to 0.6 mg/kg. Electroencephalogram (EEG) monitoring instituted to monitor for seizure activity. Laboratory workup was with in normal limit, and computed tomography (CT) brain did not reveal any intracranial bleed/mass or features of raised intracranial pressure. The patient continued to have clinical seizures once in every 40 min, for which a thiopental sodium bolus of 4 mg/Kg followed by infusion at 5 mg/kg/h was initiated. The patient continued to have focal motor seizures and EEG showed a generalization of the seizure (Fig. 13.1a). Ketamine 1 mg/kg bolus followed by 2 mg/kg/h of infusion was instituted for control of seizures clinically and electroencephalographically (Fig. 13.1b).

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Author information

Authors and Affiliations

  1. National Institute of Mental Health and Neurosciences, Bengaluru, India

    K. N. Gopalakrishna & M. Radhakrishnan

Authors
  1. K. N. Gopalakrishna
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  2. M. Radhakrishnan
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Editor information

Editors and Affiliations

  1. Division of Neuroanaesthesiology, Department of Anaesthesiology and critical care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

    Prasanna Udupi Bidkar

  2. Senior consultant and Head, Neuroanaesthesiology & Neurocritical care, MGM Healthcare Pvt Ltd, Chennai, Tamil Nadu, India

    Ponniah Vanamoorthy

Multiple Choice Question

Multiple Choice Question

  1. 1.

    The clinical/electroencephalographic seizure activity lasting longer than what period of time is defined as status epilepticus?

    1. (a)

      5 min

    2. (b)

      30 min

    3. (c)

      45 min

    4. (d)

      60 min

  2. 2.

    The following neurotransmitter alteration most likely observed with status epilepticus

  1. (a)

    Increased GABA, Increased Glutamate

  2. (b)

    Decreased GABA, Decreased Glutamate

  3. (c)

    Decreased GABA, Increased Glutamate

  4. (d)

    Increased GABA, Decreased Glutamate

  1. 3.

    All of the following drugs are used in the management of status epilepticus except?

    1. (a)

      Lorazepam

    2. (b)

      Phenytoin

    3. (c)

      Levetiracetam

    4. (d)

      Carbamazepine

  2. 4.

    Following anticonvulsant medications not suitable for administration via rectal route in children.

    1. (a)

      Diazepam

    2. (b)

      Phenobarbitone

    3. (c)

      Sodium valproate

    4. (d)

      Propofol

  3. 5.

    Alternative therapies for Refractory Status epilepticus include all except:

    1. (a)

      Vagal Nerve Stimulation

    2. (b)

      Transcranial magnetic stimulation

    3. (c)

      ketamine

    4. (d)

      Theophylline

  4. 6.

    The most common Status Epilepticus etiology in Indian adult population?

    1. (a)

      Stroke

    2. (b)

      Central nervous system infections

    3. (c)

      Anti-epileptic drug non-compliance

    4. (d)

      Neurodegenerative disorders

  5. 7.

    A 28-year-old male patient presented to casualty with generalized seizure activity that has lasted for more than 5 min. Which of the following is the first-line drug of choice to terminate seizure

    1. (a)

      Phenytoin

    2. (b)

      Sodium valproate

    3. (c)

      Lorazepam

    4. (d)

      Levetiracetam

  6. 8.

    Which of the following third-line anticonvulsant agent is appropriate for refractory status epilepticus

    1. (a)

      Fosphenytoin

    2. (b)

      Topiramate

    3. (c)

      Midazolam

    4. (d)

      Lacosamide

  7. 9.

    The following anti-epileptic drug which has no known significant interaction with enzyme-inducing drugs

  1. (a)

    Sodium valproate

  2. (b)

    Phenytoin

  3. (c)

    Levetiracetam

  4. (d)

    Topiramate

  1. 10.

    The therapeutic range of serum phenytoin level is

    1. (a)

      15–20 μg/mL

    2. (b)

      40–60 μg/mL

    3. (c)

      100–120 μg/mL

    4. (d)

      1–2 μg/mL

Answers: 1. (a), 2. (c), 3. (d), 4. (d), 5. (d), 6. (b), 7. (c), 8. (c), 9. (c), 10. (a).

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Gopalakrishna, K.N., Radhakrishnan, M. (2020). Management of Status Epilepticus. In: Bidkar, P., Vanamoorthy, P. (eds) Acute Neuro Care. Springer, Singapore. https://doi.org/10.1007/978-981-15-4071-4_13

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  • DOI: https://doi.org/10.1007/978-981-15-4071-4_13

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-4070-7

  • Online ISBN: 978-981-15-4071-4

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