Grand Rounds Collective: Status epilepticus

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.