Management of Status Epilepticus in Neuro Critical care

Management of Status Epilepticus in Neuro Critical care Brandon Foreman talk about the management of status epilepticus in neuro critical care. What are seizures? Why is this important? There are 1 million ED visits due to seizures every year with a quarter getting admitted to the hospital. 1 in 10 people will have a seizure in their lifetime. It is common. Status epilepticus is defined as seizures lasting greater than 5 minutes or recurrent seizures without interval recovery back to baseline. Practically speaking, if the person is seizing when you walk into the room or they remain comatose after they just seized, assume they are in status epilepticus. A key point - the longer the seizure, the greater the mortality. So early and effective management is critical. The first line of defence is benzodiazepines. Give it however you want, give it fast and give it in the correct dose. Brendon stresses dosage is really important. This treatment is effective, with one study showing by following a status epilepticus protocol, 74% of status epilepticus patients had resolution compared to only 29% without adequate treatment. After 20 minutes, the patient is still seizing. Now what? This condition is now defined as established status epilepticus, and you must move to second line treatments. In this category there are a lot of choices. They are of course all intravenous drugs. They all have pros and cons so use what you have available and what you are comfortable with. Again, whatever you chose, use the right dose. If after 40 minutes you are still not winning, move to the next step. At this stage the seizure might look like it is controlled due to electromechanical dissociation. However, this is commonly non-convulsive seizure activity. Get started on the third line of defence… do not muck around with more benzodiazepines or second line agents. You now move to starting an anaesthetic and securing the airway. Use whatever is available and whatever you are most comfortable with. By treating and controlling status epilepticus in under 60 minutes and you have a real chance of reducing mortality and morbidity in these patients.

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