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7 - How Do I Manage Epilepsy Emergencies Like Status Epilepticus?

Published online by Cambridge University Press:  28 January 2023

Patrick Landazuri
Affiliation:
University of Kansas Medical Centre
Nuria Lacuey Lecumberri
Affiliation:
University of Texas Health Science Center, Houston
Laura Vilella Bertran
Affiliation:
University of Texas Health Science Center, Houston
Mark Farrenburg
Affiliation:
University of Kansas Medical Centre
Samden Lhatoo
Affiliation:
University of Texas Health Science Center, Houston
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Summary

Status epilepticus (SE) is a neurological emergency defined as a continuous seizure or cluster of seizures lasting longer than 30 minutes. Because of increased mortality risk, SE is practically defined at 5 minutes. Clinically, SE can be separated into convulsive SE (CSE) or nonconvulsive SE (NCSE). For both diagnoses, the initial treatment of choice is a benzodiazepine, most commonly lorazepam 4 mg IV. Midazolam and diazepam (to a lesser extent) are also appropriate. If the status epilepticus continues, loading doses of fosphenytoin (20 mg/kg), levetiracetam (60 mg/kg), or valproate (40 mg/kg) are the next step in management. Continuation of SE past this point is considered refractory. For CSE, patients are almost always intubated and managed with IV anesthesia. For NCSE, intubation is often not needed at this point, with additional ASMs used instead to sidestep the risk associated with intubation and IV anesthesia. A key factor in guiding SE management is identifying the etiology (i.e., antibiotics for meningitis).Lastly, post cardiac arrest is briefly discussed as it is unfortunately commonly encountered.

Type
Chapter
Information
Seizure and Epilepsy Care
The Pocket Epileptologist
, pp. 129 - 138
Publisher: Cambridge University Press
Print publication year: 2023

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References

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