Lightning Learning: Status Epilepticus
“Status Epilepticus is generally defined as any single or multiple convulsions lasting 30 minutes or more.”
What?
Generalised convulsive status epilepticus is defined as:
“a generalised convulsion lasting 30 minutes or longer, or when successive convulsions occur so frequently over a 30-minute period that the patient does not recover consciousness between them.” [1]
Cerebral damage is more likely if seizure is prolonged. There are lots of different types of seizure and not all of them involve obvious convulsive activity.
Why?
There are many different causes for epilepsy:
Inheritance Tendency
Structural changes to the brain (e.g. head injury)
Space Occupying Lesions (SOL’s)
Sometimes cause cannot be determined
Epilepsy can occur at any age but commonly diagnosed in those aged below 20 or over 65 years. Incidence rate of diagnosed epilepsy is about 1:100 people, totalling over 500,000 people within the UK alone.
A seizure occurs when there is an interruption in the way in which the brain normally functions. There can be multiple triggers, but always consider concurrent illness in a child presenting in status epilepticus.
How?
Diagnosis is made through history and clinical examination. Often present either actively convulsing or minimal time between clustered seizures.
Rapid A-E assessment:
Support their airway and breathing
Gain IV/IO access
PRIMARY GOAL IS TO TERMINATE SEIZURE ACTIVITY!
Give first line benzodiazepine (buccal, IV or IO)
If x 2 staggered doses of benzodiazepine fail, give second line medication (Phenytoin or Levetiracetam as per local guidance)
If above fails to terminate seizure, activity prepare for RSI with Thiopentone
Is the child shocked?
Always consider concurrent illness. Give volume repletion and antibiotic cover. Consider radiological investigations.
Further Reading
- NICE Guidance: Treating Prolonged or Repeated Seizures and Convulsive Status Epilepticus
- University Hospitals of Leicester: Status Epilepticus in Children (Local Guideline)
