Status epilepticus full#

An electrocardiogram (ECG) should be performed. Serum should be saved for toxicology or virology or other future analyses.

Status epilepticus full#

Emergency investigationsĮmergency investigations should include assessment of the following: blood gases, glucose, renal and hepatic function, calcium, magnesium, full blood count, clotting screen, and anticonvulsant concentrations. Hypoxia is usually much worse than appreciated, and oxygen should always be administered. In all patients presenting in status, the protection of cardiorespiratory function takes first priority. General measures in the treatment of tonic-clonic status epilepticus Cardiorespiratory function The cerebral damage in status is caused by systemic and metabolic disturbance (for example, hypoxia, hypoglycaemia, raised intracranial pressure) and also by the direct excitotoxic effect of seizure discharges (which result in calcium influx into neurons and a cascade of events resulting in necrosis and apoptosis). In phase 2, however, these mechanisms break down, and there is an increasing risk of cerebral damage as the status progresses. In phase 1, compensatory mechanisms prevent cerebral damage. The physiological changes in status can be divided into two phases, the transition from phase 1 to 2 occurring after about 30–60 minutes of continuous seizures (table 2, fig 1). About 5% of all adult patients attending an epilepsy clinic will have at least one episode of status in the course of their epilepsy in children the proportion is between 10–25%. In patients with pre-existing epilepsy, status can be precipitated by drug withdrawal, intercurrent illness or metabolic disturbance, or the progression of the underlying disease, and is more common in symptomatic than in idiopathic epilepsy.

Most episodes of status develop without a prior history of epilepsy, and these are almost always caused by acute cerebral disturbances common causes are cerebral infection, trauma, cerebrovascular disease, cerebral tumour, acute toxic or metabolic disturbances, or childhood febrile illness. It occurs most commonly in children, the mentally handicapped, and in those with structural cerebral pathology especially in the frontal lobes. The annual incidence of tonic-clonic status is estimated to be 18–28 cases per 100 000 persons.