Seizures - Cases

Question 1

Tx and Dx?

Answer 1

Fast-acting drug to GET SEIZURES TO STOP!
- Benzodiazepam- if no IV access, give rectally (lower efficacy)
- Midazolam
- Propfol
- Once seizure ends, give CRI of benzodiazepam (midaz) if seizure stops. Propofol CRI if seizures don’t stop (after 3 dosages).

Long-term: start loading of keppra, or phenobarb (ideally wait for phenobarb BW to make sure healthy liver)

Dx Tests: CBC/ChemStatus, UA, thx rads
Dx: Status Epilepticus

Question 2

Status Epilepticus - Systemic Effects

Answer 2

Hypertension, Tachycardia, Hyperglycemia, Respiratory compromise, Hyperthermia

Question 3

Precaution with propofol

Answer 3

can induce sedation -> intubation likely if reach sedation

Question 4

If MRI imaging is not possible, so Pt is treated with meds, and the pt is weaned off after 1-2 weeks & recheck is normal, then likely etiology is ____ & prognosis is ____.

If deficits persist, then likely etiology is ____ & prognosis is ____.

Answer 4

Idiopathic - great if response to meds
Structural - grave (98% for meningoencephalitis of unknown etiology), poor-to-guarded for other structural lesios

Question 5

Status Epilepticus vs Cluster Seizures

Answer 5

SE is defined as continuous seizure activity of greater than 5 minutes in duration or more than one discrete seizure without regaining normal level of consciousness between the seizures.

Cluster seizures (CS), defined as greater than one seizure within 24 hours with return to normal consciousness between the seizures, is also a relatively common presenting problem, especially in dogs that have been previously diagnosed with primary or idiopathic epilepsy.

Question 6

ASD recommendation for idiopathic epilepsy with first-time cluster seizure

Answer 6

Intra-nasal midazolam, then:
- phenobarb + KBr
- pulse therapy keppra

Question 7

What is pulse therapy keppra for cluster seizures?

Answer 7

In patients with cluster seizures, give one loading dose following a seizure plus a dose every 8 hours for 3 days then stop