Status epilepticus

Ans. is ‘b’ i.e., Lorazepam

Ans. is ‘b’ i.e., Hyponatremia

Causes of status epilepticus in children

o Idiopathic                                                                                      o Drug intoxication

o Congenital/Developmental neurological abnormalities                         o Hypoglycemia

o Meningitis, Encephalitis                                                                    o Hyponatremia

o Head trauma                                                                                  o Pyridoxin deficiency

Ans. is ‘a’ i.e., Lorazepam

o Drug used are Lorazepam, Clonazepam, Diazepam, Phenytoin, Phenobarbitone, Thiopentol, Propofol, Midazolam. 0 Lorazepam i.v. is now the preferred initial choice.

Ans is ‘a’ i.e., Arachinioidits, ‘b’ i.e., Mental retardation, ‘c’ i.e., Status epilepticus

Ans. is ‘c’ i.e., Lamotrigine

A i.e. IV diazepam

Status epilepticus is said to occur when seizures lasts beyond 30 minutes or seizures are repetitive, prolonged & the patient remains unconscious in between the seizures.

The drug of choice is /V Lorazepam (Benzodiazipine)Q 0.1 mg/kg at rate of 2 mg/min.

Pharmacologic treatment of generalized tonic-clonic status epilepticus in adults. IV, intravenous, PE, phenytoin equivalents. The horizontal bars indicate the approximate duration of drug infusion.

Answer is D (Carbamazepine) :

First choice drugs            Second choice drugs             Alternative / Add on drugs

Diazepam (I.V.)               Phenytoin (I.V.)                      General Anaesthetic e.g.

Clonozepam (I.V.)           Phenobarbitone (I.V. I.M.)       Thiopentone sodium (KDT

Lorazepam (I.V.)                                                        

Thiopentone sodium can occasionally be used for rapid control of convulsions – KDT

Answer is D (Carbamazepine) :

Carbamazepine is the most effective drug for complex partial seizures and shares first choice drug status with phenytoin fior generalized tonic clonic seizures and simple partial seizures. It is however not indicated in status epilepticus.

Answer is D (Lorazepam):

Although Valproate and Limotrigine are the agents offirst choice in cases of Generalized Tonic Clonic Seizures, they are not the preferred agents if the patient presents in status epilepticus. The patient in question is presenting in status epilepticus hence the initial agents of choice is Lorazepam.

First choice drugs in status epilepticus

Diazepam (I. V.)

Clonozepam (I. V.)

Lorazepam (I.V.)

Ans. C: Lorazepam

Intravenous Lorazepam is now the treatment of choice for controlling seizures in status epilepticus

Status epilepticus/SE

• It is a life-threatening condition in which the brain is in a state of persistent seizure.
• Definitions vary, but traditionally it is defined as one continuous unremitting seizure lasting longer than 5 minutes, or recurrent seizures without regaining consciousness between seizures for greater than 5 minutes.
• It is always considered a medical emergency.
• There is some evidence that 5 minutes is sufficient to damage neurons and that seizures are unlikely to self-terminate by that time.
• The mortality rate of status epilepticus has the potential to be quite high (at least 20%), especially if treatment is not initiated quickly.
• Only 25 percent of people who experience seizures or status epilepticus have epilepsy.
• Causes include:

– Stroke

– Hemorrhage

– Insufficient dosage of a medication already prescribed to the patient. Such causes of this include:

• Forgetfulness on the part of the patient in taking scheduled doses, or failure to take doses at the scheduled times
• Taking medicine at wrong times as a result of a time zone change while traveling
• Dislike of the medication or its side effects

– Sudden withdrawal from a seizure medication. Such causes include:

– Consumption of alcoholic beverages while on an anticonvulsant, or alcohol withdrawal.

Dieting or fasting while on an anticonvulsant

– Starting on a new medication that reduces the effectiveness of the anticonvulsant

– Developing a resistance to an anticonvulsant already being used

Gastroenteritis while on an anticonvulsant. This is because the digestive system may force out the anticonvulsant, thereby rendering the body with a lack of protection

–  Metabolic disturbances—such as affected kidney and liver

• Status epilepticus can be divided into two categories — convulsive and nonconvulsive, the latter of which is underdiagnosed
• The benzodiazepine of choice is lorazepam for initial treatment due to its relatively long (2-8 hour) duration of action 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 solubility 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.
• Particularly in children another, increasingly popular treatment choice is buccal and intranasal midazolam, which can be given into the side of the mouth.

Ans. D i.e. Lorazepam