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EPILEPSY/
STATUS EPILEPTICUS
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EPILEPSY
Epilepsy is a paroxysmalneurological disorder and ischaracterized by recurrent episodesof convulsive movements or other
motor activity, loss of consciousness,sensory disturbances, and otherbehavioral abnormalities.
Because epilepsy occurs
in more than 50 diseases,it is considered a syndromerather than a disease.
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Convulsive seizures are the most common
forms of attacks of epilepsy. Seizures occurwith abnormal electrical discharges from brain
cells, and these discharges are caused by the
movement of ions across the cell membrane.
Although seizures are the dominant
manifestation of epilepsy, patients can
have a seizure and not have epilepsy.
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Status epilepticusis a clinical or electricalseizure lasting at least 30 minutes, or a series
of seizures without complete recovery over
the same period of time.Pseudoseizures are the physical
appearance of seizure activity without the
cerebral electrical activity.
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CAUSESA. Central nervous system (CNS) disorders
1. potential mass effect (tumor, abscess, atrioventricular malformation,aneurysm, or hematoma)
2. strokes, especially those that are embolic.
B. Metabolic or systemic disorders
1. acute overdose
2. acute drug withdrawal (especially CNS depressants, alcohol,
benzodiazepines, and barbiturates)
3. febrile states
4. Hypoxia
5. Hyperosmolarity6. hypertensive encephalopathy
7. Hyperthermia
8. electrolyte disturbances
C. Idiopathic origins
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classifications
I. PARTIAL (FOCAL, LOCAL)
SEIZURES
A. Simple partial seizures: No
impairment of consciousness
B. Complex partial seizures:
Impaired consciousness,
frequently include automatisms C. Partial seizures that
secondarily generalize
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II. SEIZURES: All have impairment of
consciousness
A. Absence (previously known as petitmal) of blank stare; generally in
children
B. Myoclonic seizures: Short, abrupt
muscular contractions
C. Clonic seizures: Muscle contractionand relaxation
D. Tonic seizures: Abrupt increase in
muscle tone
E. Tonic-clonic seizures (previouslyknown as grand mal): quick, bilateral,
severe jerking movements
F. Atonic seizures (drop attacks):
Abrupt loss of muscle
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III. Unclassified epileptic seizures: Inadequate
or incomplete data to identify classification
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DIAGNOSTICS HIGHLIGHTSTest Normal
Result
Abnormality with
Condition
Explanation
Magneticresonance
imaging
(MRI)
Normalbrain
structures
Assesses the centralnervous system for
changes in brain
structure
such as atrophy of
certain areas or brain
tumors
Structural brain changes such assclerosis, tumors, infarcts, or atrophy
can lead to seizures
Electro-
encephalo-
gram
(EEG)
Normal
patterns
of
electrical
activity
Assesses the central
nervous system for
changes in brain
structure
such as atrophy of
certain areas or brain
tumors
Recording of electrical potentials
based on distribution of waveforms
generated by cerebral cortex
of brain; waveforms demonstrate
abnormal patterns during
seizures; they are not useful inthe acute management of status
epilepticus
Other Tests: Computed tomography (CT) scans, positron emission tomography (PET),
and skull x-rays; serum laboratory data to explore possible causes include glucose;
calcium; blood urea nitrogen (BUN); and electrolyte, toxic, and metabolic screens
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DIAGNOSTICS HIGHLIGHTS
Medicatio
n or
Drug Class
Dosage Description Rationale
Anticonv
ulsants
Varies
with
drug
Multiple drug
therapies
are available:
Phenytoin
sodium
(Dilantin),
phenobarbitol,
lorazepam
(Ativan),diazepam
(Valium).
Lorazepam (Ativan) or diazepam
(Valium) may be used to stop seizures
quickly. Phenytoin (Dilantin) is
preferred
maintenance anticonvulsant for
status
epilepticus. A newer drug,
fosphenytoin
(Cerebyx), has been developedthat is safer for parenteral
administration.
Phenobarbitol may be given if
seizures occur after phenytoin
loading.
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Other: Thiamine 100 mg and 50 ml of 50% dextrose inwater may be administered in an emergency to rule
out seizures because of thiamine deficiency orhypoglycemia.
Other Information about Anticonvulsants: The primarytreatment for epilepsy is one or more of the multitudeof antiepileptic drugs (AED) or anticonvulsants. Thechoice of AED or combination of AEDs depends onseizure type, patient tolerance, and cost.
Carbamazepine (Tegretol) is a widely used andcost-effective anticonvulsant. Valproic acid, primidone
(Mysoline), clonazepam, and ethosuximide areprescribed, depending on the seizure type. Lamotrigine(Lamictal) is a new AED approved as adjunctive therapyand single therapy for partial seizures.
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Surgical Treatment
1. A proportion of the pts with intractable epilepsywill benefit from surgery.
2. Epilepsy surgery procedures: Curative (removalof epileptic focus) and palliative (seizure-related
risk decrease and improvement of the QOL)3. Curative (resective) procedures: Anteromesial
temporal resection, selectiveamygdalohippocampectomy, extensive
lesionectomy, cortical resection,hemispherectomy.
4. Palliative procedures: Corpus callosotomy andVagal nerve stimulation (VNS).
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STATUS EPILEPTICUS
SE is a common medical and one of the
most serious neurological emergency
associated with high mortality and morbidity.
SE refers to a condition in which there is a
failure of the normal factors that serve to
terminate a typical seizure. SE may be
classifies based solely on the presence orabsence of convulsions into convulsive SE
(CSE) and non-convulsive SE (NCSE).
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ALGORITHM FOR TREATMENT OF
CONVULSIVE STATUS EPILEPTICUS
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fin.
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