Status Epilepticus Treatment in Noida, Delhi Ncr, India

Overview

Status epilepticus is a medical emergency characterized by a seizure lasting longer than 5 minutes or multiple seizures within 5 minutes without the individual regaining normal consciousness. This condition can lead to permanent brain damage or death if not promptly treated.

Types of Status Epilepticus

Status epilepticus presents in two forms:

1. Convulsive Status Epilepticus: This form involves prolonged or repeated tonic-clonic (grand mal) seizures, typically lasting 1 to 2 minutes but sometimes extending longer. Symptoms include jerking motions, grunting sounds, drooling, and rapid eye movements.
2. Nonconvulsive Status Epilepticus: This involves prolonged absence or focal impaired awareness (complex partial) seizures. Symptoms are more subtle and include confusion, a daydreaming appearance, and inability to speak.

Symptoms

Symptoms of status epilepticus include:

• Falling
• Confusion
• Unusual noises
• Loss of bowel or bladder control
• Clenched teeth
• Irregular breathing
• Unusual behavior
• Difficulty speaking
• A “daydreaming” look
• Continuous jerks in head, limbs, or face

Causes

In children, status epilepticus is often caused by infections with fevers. In adults, common causes include:

• Strokes
• Low blood sugar or sodium levels
• Excessive alcohol consumption or withdrawal
• Head injury
• Brain infection or septicemia
• Kidney or liver failure

Diagnosis

Diagnosis involves various tests, such as:

• Arterial blood gas tests
• Renal and liver function tests
• Complete blood counts
• Glucose and electrolyte level tests
• Toxicological screening
• Prolonged Electroencephalography (EEG)

Other possible tests include blood cultures, urinalysis, CT or MRI scans of the brain, chest X-rays, and lumbar puncture for CSF studies.

Treatment

At Home

First-line treatment at home involves:

• Ensuring the person’s head is safe
• Moving the person away from danger
• Administering resuscitation if needed
• Giving emergency medication if available, such as midazolam or diazepam
• Not putting objects in the person’s mouth
• Positioning them laterally

At the Hospital

Hospital treatment includes:

• Administering high-concentration oxygen and intubation
• Assessing cardiac and respiratory function
• Injecting intravenous (IV) medications to suppress seizure activity
• Conducting emergency investigations like blood gases, renal and liver function tests, and AED levels

Complications

Complications range from none to severe, including physical disability or death, depending on the underlying cause.

Risk Factors

Risk factors for status epilepticus include:

• Poorly controlled epilepsy
• Stroke
• Alcohol or drug abuse
• Kidney or liver failure
• Encephalitis
• HIV
• Low blood sugar
• Head injuries
• Sudden withdrawal of antiepileptic drugs

Prognosis

Prognosis varies, with mortality rates ranging from 3% to 50% in large hospital-based studies. Factors associated with higher mortality include refractory seizures, acute symptomatic etiologies, impaired consciousness, longer seizure duration, and older age.

Reviewed & Updated On Reviewed by Dr. Neeraj Kumar, Sr. Consultant – Neurology on 03-July-2024.