Status epilepticus is a medical term that refers to either a lengthy seizure without an apparent respite or a series of seizures without the patient regaining consciousness. It is a medical emergency with an estimated mortality rate of approximately 10 percent and requires immediate treatment. Status epilepticus can be the first indication of epilepsy; occur secondary to a primary and preexisting condition such as an electrolyte imbalance, head trauma or alcohol withdrawal; or indicate insufficient anticonvulsant medication coverage for a patient with a known seizure condition. Treatment of status epilepticus requires emergency treatment by first responders and immediate transportation to a hospital emergency department. Throughout this critical period, treatment of status epilepticus involves ensuring an adequate airway and oxygenation, establishing an intravenous (IV) line for administration of critical medication and fluid, resolving the seizure by IV medication or anesthesia and finally determining the cause of the seizure to prevent a recurrence.
Ensuring that a patient has an adequate airway is paramount in the treatment of status epilepticus. Not only may a patient's convulsions interfere with normal respiratory effort, but also the intense muscular contractions burn an enormous amount of oxygen, creating a systemic oxygen deficit that can cause brain damage. The patient's oxygen levels must be monitored with arterial blood gases or a pulse oximeter probe to assess the extent of hypoxia. Supplemental oxygen should be administered by nasal cannula or the patient may be intubated — undergo the process of inserting a breathing tube into the trachea — to provide respiratory support with mechanical ventilation.
Treatment of status epilepticus requires the establishment of one or more patent IV sites in order to allow rapid administration of fluid and medications as well as to provide access for blood samples for immediate evaluation. A bedside blood glucose level can help evaluate whether the seizure is diabetic in origin. Laboratory samples should include a standard blood count, an electrolyte series, and a toxicology screen as well as anticonvulsant medication levels if the patient is on medication for a known seizure disorder. Benzodiazepines and anticonvulsants are generally administered by IV in order to have the fastest effect and attempt to ameliorate or eliminate the seizure. If the patient fails to respond to this therapy, he may be fully sedated by placing him under anesthesia to stop the convulsions.
Ongoing electroencephalography (EEG) is also recommended during treatment of status epilepticus in order to directly record ongoing seizure activity and assess for the efficacy of the ongoing treatment. An EEG measures brain electrical activity, including that of seizures. Evaluation with an EEG helps determine if the patient is still undergoing partial seizures despite sedation with benzodiazepines. After provision of life-sustaining measures, determination of the seizure etiology becomes the goal in treatment of status epilepticus.
