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Grand Rounds Collective: Status epilepticus
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Speaker:
Thomas Bleck, MD, MCCM, FNCS
Professor of Neurology, Northwestern Feinberg School of Medicine
Professor Emeritus of Neurological Sciences, Neurosurgery, Medicine, and Anesthesiology, Rush Medical College
Summary: A discussion about status epilepticus and its causes and treatments with a further look into management of refractory status.
Key Points:
• Status epilepticus, a continuous seizure or repetitive seizures for 30 without recovery, is generally classified as convulsive versus non convulsive. A spontaneous seizure's likelihood of progressing to status increases as its duration increases.
• Treatment of status epilepticus initially is with intravenous Lorazepam or intramuscular Midazolam. Levetiracetam, Fosphenytoin and Valproate are all efficacious in cessation of benzodiazepine refractory seizures.
• Refractory status epilepticus treatment can be with a benzodiazepine or propofol continuous infusion with a goal of burst suppression however burst suppression does not guarantee prevention of further seizures. In further refractory status, treatment with barbiturates or potentially ketamine can be considered.
• Management of SE may include intubation preferably with a non-depolarizing NMJ blocking agent to avoid activating overly sensitive receptors and causing potentially fatal hyperkalemia.
Thomas Bleck, MD, MCCM, FNCS
Professor of Neurology, Northwestern Feinberg School of Medicine
Professor Emeritus of Neurological Sciences, Neurosurgery, Medicine, and Anesthesiology, Rush Medical College
Summary: A discussion about status epilepticus and its causes and treatments with a further look into management of refractory status.
Key Points:
• Status epilepticus, a continuous seizure or repetitive seizures for 30 without recovery, is generally classified as convulsive versus non convulsive. A spontaneous seizure's likelihood of progressing to status increases as its duration increases.
• Treatment of status epilepticus initially is with intravenous Lorazepam or intramuscular Midazolam. Levetiracetam, Fosphenytoin and Valproate are all efficacious in cessation of benzodiazepine refractory seizures.
• Refractory status epilepticus treatment can be with a benzodiazepine or propofol continuous infusion with a goal of burst suppression however burst suppression does not guarantee prevention of further seizures. In further refractory status, treatment with barbiturates or potentially ketamine can be considered.
• Management of SE may include intubation preferably with a non-depolarizing NMJ blocking agent to avoid activating overly sensitive receptors and causing potentially fatal hyperkalemia.
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