Status epilepticus
INTRODUCTION:
- Staus Epilepticus refer to continuous seizures or reparative, discrete seizures with impaired consiousness in the interictal period
- Seizure activity not resolving spontaneously , or recurrent seizures with no recovery of conciousness in between
ETIOLOGY:
- Acute symptomatic, remote symptomatic & idiopathic causes
- Anticonvulsant withdrawal or non-compliance -GCSE
- Common etiology:
- H/O previous CNS insult
- Infection- meningitis & encephalitis
- Metabolic derrangement
- Hypoglycemia , Hyponatremia
- Neoplasia or Tumor
- Drug toxicity
- Acute stroke
- Alcohol intake
- Anoxia/Hypoxia
- Infection with fever(meningitis) is the most common cause in children
CLINICAL FEATURES:
- Prolonged rigidity &/or clonic movements with loss of awareness
- As seizures activity becomes prolonged, movements may become more subtle- Mild clonic movements of only the fingers & fine rapid movements of eyes
- There may be proxysmal episodes of tachycardia, hypertension & pupillary dilation
- Cynosis, pyrexia, acidosis & sweating may occur
COMPLICATIONS:
- Aspiration
- Hypotension
- Cardiac Arrythmias
- Renal Failure
- Hepatic Failure
- Epilepsy
- Encephalopathy
- Focal neurological deficit
MANAGEMENT:
OPIOIDS
- Morphine acts by agonistic activity on μ, K and δ receptors.
- The drug of choice for status epilepticus is Lorazepam
- In status epilepticus, drug of choice is IV diazepam
- Receptor for opioid system – G protein-coupled orphanin opioid-receptor-like subtype1 (ORL1).
- A child in status epilepticus should be given Clonazepam, Phosphenytoin & Diazepam
- Its endogenous ligands are nociceptin /orphanin FQ (N/OFQ System).
- Nociceptin: similar to dynorphin but acts only at the ORL1 receptor.
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Opioids |
Natural opioids |
Morphine, Codeine |
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Semisynthetic opioids |
Diacetyl morphine (Heroin), Pholcodeine |
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Synthetic opioid |
Pethidine(Meperidine), Fentanyl, Methadone, Dextropropoxyphene, Tramadol |
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Complex Action opioid & antagonists |
Agonist- antagonist |
Nalorphine, Pentazocine, Dezocine, Meptazinol, Butorphanol |
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Partial/weak μ agonist + K antagonist |
Buprenorphine |
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Pure antagonists |
Naloxone, Naltrexone, Nalmefene |
Exam Question
- The initial drug of choice for status epilepticus is Lorazepam
- Causes of status epilepticus in a child Hyponatremia
- Status epilepticus is the complication (s) of meningitis in a child
- A child in status epilepticus should be given Clonazepam, Phosphenytoin & Diazepam
- In status epilepticus, drug of choice is IV diazepam
Don’t Forget to Solve all the previous Year Question asked on Status epilepticus
