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The app is regularly updated to align with the latest NEET PG exam patterns and includes new questions as per evolving trends in medical entrance exams.

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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.

Opioids	Natural opioids	Morphine, Codeine
	Semisynthetic opioids	Diacetyl morphine (Heroin), Pholcodeine
	Synthetic opioid	Pethidine(Meperidine), Fentanyl, Methadone, Dextropropoxyphene, Tramadol
Complex Action opioid & antagonists	Agonist- antagonist	Nalorphine, Pentazocine, Dezocine, Meptazinol, Butorphanol
	Partial/weak μ agonist + K antagonist	Buprenorphine
	Pure antagonists	Naloxone, Naltrexone, Nalmefene

Exam Important

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

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Status epilepticus