Status Epilepticus

Convulsive Status Epilepticus aredefined as either:

– Generalised convulsion lasting >30 minutes

– Multiple convulsions without regaining consciousness over 30min

However, start intervention for convulsion lasting >5min, as these may not stop spontaneously & the longer they continue, the difficult they are to control.

Common causes of CSE in children:

– Prolonged febrile convulsions

– Hypoglycemia

– Hypoxia

– Sepsis / Meningitis

– Low Na+, Mg+, Ca++

– Drug toxicity

– Raised ICP (consider NAI)

 

Assessment:

Airway + Oxygen

Breathing– is support needed

Circulation– vascular access?

Disability assessment/ GCS monitoring

Exposure– temp, rash, etc

Glucose, Gas- check

Start monitoring- SaO2, HR

Complications:

– Cardiac arrhythmias

– Hypertension

– Pulmonary oedema

– Hyperthermia

– Myoglobinuria

– DIC

 

Management:

– If expecting CSE, inform senior doctor

– Ensure correct timing of seizure onset

– Ask if any benzodiazepine given already

– Immediately perform ‘primary assessment’ of ABC, D, E & Glucose

– Treat any associated illness or metabolic abnormality rapidly

– Avoid hyponatremia, restrict fluids 

– Consider interventions to reduce ICP

– Liaise early with anaesthetists & PICU