Table of Contents
What is the best drug of choice for status epilepticus?
BENZODIAZEPINES. The benzodiazepines are some of the most effective drugs in the treatment of acute seizures and status epilepticus. The benzodiazepines most commonly used to treat status epilepticus are diazepam (Valium), lorazepam (Ativan), and midazolam (Versed).
What is the IV drug of choice for status epilepticus?
Continuous infusion of IV midazolam is used in the management of refractory status epilepticus. (See “Refractory status epilepticus in adults”, section on ‘Midazolam’.) Clonazepam – Outside the United States, IV clonazepam (0.015 mg/kg) is commonly used as a first-line therapy for status epilepticus [15,33].
What happens to breathing during seizure?
During a tonic-clonic or grand mal seizure (think convulsive seizure), it may look like the person has stopped breathing. This is because the chest muscles tighten during the tonic or “stiffening” part of seizure. The person will usually start breathing on his or her own after the seizure.
Why do you give lorazepam for status epilepticus?
Lorazepam, when available, is thought to be the most effective and has a longer seizure half-life than diazepam. Because the effect is time limited, loading of a traditional AED, such as phenytoin, is recommended soon after administration to help mitigate seizure recurrence.
Why is Ativan given for seizures?
Ativan binds to a type of GABA receptor, called GABAA, and activates it in a similar way to GABA. GABA is a signaling molecule that inhibits nerve cell signaling. Through this mechanism, Ativan is thought to reduce the uncontrolled firing of neurons that causes seizures.
How do you break a status epilepticus?
Early status epilepticus It is usual to initiate treatment with a fast acting benzodiazepine, and intravenous lorazepam is the drug of choice. Alternatives include other intravenous benzodiazepines or intravenous lignocaine, the latter possibly being preferable in patients with respiratory disease.
Should you intubate a seizure patient?
In the emergency treatment of patients with generalized seizure, especially those with status epilepticus, tracheal intubation (TI) is sometimes required in order to secure the airway and support respiration (1).
Why would you be put on a ventilator after a seizure?
Patients who are hypoventilating during a seizure, remain hypoxic despite high-flow oxygen or have poor respiratory effort require assisted ventilation with a bag-valve mask connected to oxygen.
What is a status epilepticus seizure?
Status epilepticus. Status epilepticus is an acute and prolonged seizure that persists for a sufficient length of time or is repeated frequently enough that recovery between attacks does not occur. It is a clinical emergency associated with high morbidity and mortality.
What is persistent non-convulsive status epilepticus (NCSE)?
An inability to regain consciousness raises concern for persistent non-convulsive status epilepticus (NCSE). Continuous vEEG is preferred (especially for more complex patients). For patients who don’t regain normal consciousness, intermittent seizures may be occurring which could be missed with a single “spot” EEG.
How long does a refractory status epilepticus seizure last?
(3) Absence seizure lasting >10-15 minutes. Refractory Status Epilepticus (RSE) : Refractory to first- and second-line antiepileptic agents (e.g., benzodiazepine plus levetiracetam).
What are the three types of status epilepticus?
Status Epilepticus, Refractory Status Epilepticus, and Super-refractory Status Epilepticus. Continuum (Minneap Minn). 2018 Dec;24 (6):1683-1707. doi: 10.1212/CON.0000000000000668 [ PubMed]