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Neuro > Status Epilepticus > Flashcards

Status Epilepticus Flashcards

1
Q

What is the definition of SE?

A

Seizure lasting > 30min of either:
Continuous seizure activity
OR
2 or more sequential seizures w/o an intervening period of consciousness between seizures

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2
Q

What is the least common form of SE?

A

NCSE (nonconvulsive SE)

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3
Q

What are the most common and severe form of SE?

A

GCSE

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4
Q

What are the types of seizures in GCSE?

A

Tonic clonic

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5
Q

What are type I GCSE?

A

Not associated with structural lesions

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6
Q

What causes type I GCSE?

A

Infection (pediatrics)

Low AED levels

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7
Q

What are type II GCSE?

A

Associated with structural lesions

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8
Q

What causes type II GCSE?

A 
Congenital malformations (pediatrics)
CVA (adults)
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9
Q

Which type of GCSE has the worst prognosis?

A

Type II

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10
Q

What are most episodes of SE d/t?

A

Acute anticonvulsant WD
Metabolic d/o or concurrent illness
Progression of a pre-existing neurologic dz

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11
Q

What are the causes of GCSE in < 1yo?

A

Acute encephalopathy

Metabolic disorders

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12
Q

What are the causes of GCSE in adults?

A

CVA dz
WD of anticonvulsants
Low anticonvulsant serum concentrations

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13
Q

What are the phases of SE?

A

Phase I - Occurs in the 1st 30 minutes of seizure

Phase II - Patient begins to decompensate

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14
Q

What is the clinical presentation of SE?

A

Impaired consciousness
Disorientation once GCSE is controlled
Pain associated with secondary injuries

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15
Q

What are the early signs of SE?

A

Acute injuries/CNS insults that cause extensor/flexor posturing
Hypothermia/fever which may indicate underlying illness such as sepsis or meningitis
Evidence of head/other CNS injury
Generalized convulsions, muscle contractions, spasms
Incontinence
Normal BP/hypotension
Respiratory compromise

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16
Q

What are late signs of SE?

A 
Clinical seizures may or may not be apparent
Pulmonary edema w/respiratory failure
Cardiac failure
Hypo/hypertension
DIC/multi-organ failure
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17
Q

What are lab tests for SE diagnosis

A 
CBC w/diff
CMP
Urine drug/alcohol screen
Blood cultures
ABG
Drug concentration
18
Q

What are other diagnostic tests for SE?

A 
LP
EEG
CT
MRI
Radiograph
ECG
19
Q

What are the short term goals for SE?

A

Immediate termination of all clinical and electrical seizure activity
No clinically significant SE
Lack of recurrent seizure activity

20
Q

What are the long term goals of SE?

A

Minimize and/or avoid likelihood of pharmacoresistant epilepsy
Minimize and/or avoid the development of neurologic sequelae

21
Q

What are the pharmacologic treatment goals?

A

Patient stabilization
Accurate diagnosis of the subtype of GCSE and identification of precipitating factors
Termination of clinical and electrical seizures
Prevention of seizure recurrence

22
Q

What are the 1st line therapies for SE?

A

Benzos IV

Lorazepam, diazepam, midazolam

23
Q

What is administered after benzos in SE?

A

Phenytoin
Fosphenytoin
Phenobarbital
Keppra

24
Q

How does phenytoin work in SE?

A

Stabilizes neuronal membranes by decreasing na influx/increasing na efflux through VSCC blockade

25
Q

What must be monitored with pheny?

A

VS
ECG
pH

26
Q

What is a AE of pheny?

A

Purple glove syndrome

27
Q

What is the max infusion rate of phenytoin?

A

50mg/min

28
Q

What is the dose of fosphenytoin?

A

15-20 PE/kg

29
Q

What are dose and infusion time related in fosphenytoin

A

Paresthesia and pruritus

30
Q

What are AE if fosphenytoin?

A

Nystagmus
Dizziness
Ataxia

31
Q

When is phenobarb recommended in SE?

A

Failure of benzo plus phenytoin

32
Q

What is refractory GCSE?

A

Adequate doses of benzo, phenytoin or fosphenytoin, or phenobarb have failed

33
Q

What is the benzo of choice in refractory GCSE?

A

Midazolam

34
Q

What would increase the rate of infusion of midazolam?

A

Tachyphylaxis

35
Q

What are the treatment of refractory GCSE?

A 
Benzo
Medically induced coma
VPA
Keppra and Lacosamide
Propofol
36
Q

What are the treatments for super refractory SE?

A

Oral topamax
Ketamine
IV lidocaine

37
Q

What drugs are used for medically induced comas?

A

Pentobarbital

Thiopental

38
Q

Is VPA FDA approved for GCSE?

A

No, but used in ped and adults

39
Q

What is propofol infusion syndrome?

A

Respiratory depression, cerebral depression and bradycardia

40
Q

What is ketamine?

A

Non-competitive NMDA receptor antagonist that blocks glutamate

Neuro (13 decks)

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