Pediatrics
Definitions
- Seizures that persist without interruption for more than 5 minutes
- Two or more sequential seizures without full recovery of consciousness between seizures
- This is a life-threatening emergency that requires immediate treatment.
Occurrence and Complications
- Commonly occurs in children with epilepsy (9-27% over time).
- Complications result from both the impact of the convulsive state on the body systems (such as the cardiac and respiratory systems) and the neuronal cellular injury which leads to cell death.
- Rapid termination of the seizure activity protects against neuronal injury.
Types, Incidence & Description
| Type | Incidence | Description |
|---|---|---|
| Remote Symptomatic SE | 33% | SE with no immediate event but the child had a previous history of CNS malformation, traumatic brain injury, or chromosomal disorder |
| Acute Symptomatic SE | 26% | SE with concurrent acute illness (e.g., meningitis, encephalitis, hypoxia, trauma, intoxication) |
| Febrile SE | 22% | SE with a febrile illness but not a Central Nervous System infection (e.g., sinusitis, sepsis, upper respiratory infection) |
| Cryptogenic SE | 15% | SE with no identifiable cause |
Therapeutics
Status epileticus:
Defined as recurrent or continuous seizure activity lasting longer than 30 minutes in which the patient baseline consciousness is not regained between the seizures. OR occurrence of serial convulsions between which there is no return of consciousness - Can lead to systemic hypoxia, acidosis, hyperpyrexia, cardiovascular collapse and coma . Death occurs in 5-10%.
Treatment:Y
status epilepticus is life-threatening and must be treated immediately with concomitant cardiovascular, respiratory and metabolic management.
- diazepem 10 mg I.V. repeat dose (5-10 mg) every 20-30 min.
- clonazepam 1mg I.V. repeat dose (2-6 mg) every 20-30 min
- phenytoin 10-20 mg I.V.
- phenobarbitone 10-20 mg/kg slow I.V.
- general anesthesia with propofol or thipentone should be commenced immediately; for muscle relaxation
Causes of Status Epilepticus
- Prolonged febrile seizure (commonest) cause.
- Idiopathic status epilepticus
- Non-compliance to anti-epileptics
- Sudden withdrawal of anti-epileptics
- infection
- Others…..