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41 Cards in this Set
- Front
- Back
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International League Against Epilepsy definition of status epilepticus
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30 minutes of continued seizure or two seizures in thirty minutes without full recovery in between
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Newer operational definitions for time seizures should be let go before they are treated
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5 minutes
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Most commonly encountered form of status epilepticus
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Generalized convulsive status
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Tonic activity
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sudden tensing of muscles
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Clonic activity
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Tensing and relaxing over and over again
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Signs of non-convulsive SE
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nystagmus, eye twitching, subtle rhythmic finger or toe movements
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What is the most common type of non convulsive SE?
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complex partial SE
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Patient presents with confusion/combative, in "twighlight" state, bizarre behavior and automatisms. What could it be?
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Complex partial SE
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In what setting does myoclonic SE present?
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After severe neurological insults, like anoxia & toxic/metabolic states
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Features that can distinguish pseudoseizures from actual ones
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Nonrhythmic movements, pelvic thrusting, biting the TIP of tongue (vs. the side, which is what really happens)
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How is SE maintained?
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through lack of appropriate GABA mediated suppression
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What is hypothesis as to why resistance to benzodiazepines eventually developes?
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Because with sustained seizure activity, new GABA isoforms with different properties develop
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What is the proposed role of NMDA in seizures?
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Might be causing neuronal stimulation- possibility of treating with NMDA antagonists?
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How do you treat seizures due to electrolyte abnormalities?
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Fix the electrolyte abnormality
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Why do you want to avoid long-acting neurmuscular paralysis when intubating seizure patient?
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Because it could mask seizure activity
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Give two cases of status in which you'd want to continue to monitor a pt. with EEG?
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If seizures don't respond to first/second line drugs or if subtle signs of seizure are still present
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When you think you need EEG monitoring but can't get it, what can you do?
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Put pt. under short-acting anesthetic (propofol, thiopental)
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Mechanism of action of benzos in stopping seizures?
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GABA-A agonist --> chloride channel hyperpolarization
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Give initial and loading dose for lorazepam
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initial 4-8 mg, loading .1-.2mg/kg
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Give two instances when midazolam would be used to treat seizure?
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1) parents can administer to kids
2) Used out of hospital 3) commonly used as an IV infusion for RSE |
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Second line treatment for SE?
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Phenytoin
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Mechanism of action of phenytoin?
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barbiturate-like, decreased recovery rate of voltage-activated sodium channels
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Loading dose of phenytoin?
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20 mg/kg
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Side effects of phenytoin?
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Hypotension, bradycardia, prolonged QT; need ecg during infusion
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Other meds. that could be used in treatment of SE?
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valproic acid, levetiracetam, phenobarbitol (third line)
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First line treatment for RSE?
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Midazolam IV infusion
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What is black box contraindication for propofol in children?
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can develop a metabolic acidosis + hypotension, rhabdomyolysis, and hyperlipidemia; might beassociated with a mitochondrial enzymatic deficiency
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Name other drugs to try for RSE besides midazolam and propofol.
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Pentobarbitol, thiopental, ketamine, isofluorane (super last choice)
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When do you usually need to intubate in SE?
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After loading dose of benzos are given, intubation usually required.
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Decreased consciousness results from dysfunction of either __ or __?
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Bilateral cerebral hemispheres, brainstem reticular activating system
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Where do generalized seizures localize to?
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Bilateral cerebral cortices
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Doll's eye tests what?
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Horizontal eye movements if pt. can't follow instructions
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Decreased consciousness + normal eye movements suggests lesion where?
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both cerebral hemispheres (vs. brainstem)
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What causes transient hyperreflexia after generalized seizure?
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reversible alterations in the neuronal function
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postictal Todd's paralysis suggests what?
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That there is a focal brain lesion and focal onset of seizure
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What imaging would you do on a seizure patient?
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CT brain without contrast
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Why check coags in seizure patient?
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look for coagulopathies that could predispose to intracranial hemorrhage
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What magnesium abnormality can lower the seizure threshold?
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HYPO
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What is mild leukocytosis after seizure due to?
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demargination of WBCs
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What is a normal therapeutic range of phenytoin?
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10-20
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MUST intubate before...
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giving barbiturates
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