Medical Surgical Nursing || Neurological Emergency || Status Epilepticus || Nursing Alert ||

 

Status Epilepticus :

Definition

Status Epilepticus (SE) is a neurological emergency characterized by continuous seizure activity lasting more than 5 minutes or recurrent seizures without regaining consciousness between episodes. It is a life-threatening condition requiring immediate medical attention to prevent permanent neurological damage or death.

---

Causes

1. Epilepsy-related Causes:

   • Sudden discontinuation of anti-epileptic drugs (AEDs)
   • Poor adherence to AED therapy

2. Structural Causes:

   • Traumatic brain injury (TBI)
   • Stroke
   • Brain tumors

3. Metabolic Causes:

   • Hypoglycemia or hyperglycemia
   • Hyponatremia or hypernatremia
   • Hypocalcemia

4. Infections:

   • Meningitis
   • Encephalitis
   • Brain abscess

5. Toxic and Drug-related Causes:

   • Alcohol withdrawal
   • Drug intoxication (e.g., cocaine, amphetamines)
   • Overdose of certain medications

6. Other Causes:

   • Fever (Febrile seizures in children)
   • Eclampsia in pregnancy

---

Signs and Symptoms

1. Motor Symptoms:

   • Continuous jerking or twitching movements
   • Tonic-clonic seizures
   • Myoclonic jerks

2. Non-motor Symptoms (Absence SE):

   • Staring episodes
   • Decreased responsiveness

3. Autonomic Symptoms:

   • Tachycardia
   • Hypertension
   • Increased salivation or frothing at the mouth

4. Neurological Symptoms:

   • Altered consciousness
   • Confusion or disorientation

---

Investigations

1. Clinical Evaluation:

   • Detailed patient history (e.g., seizure history, medication compliance)
   • Physical and neurological examination

2. Laboratory Tests:

   • Blood glucose levels
   • Electrolyte panel (sodium, calcium, potassium)
   • Renal and liver function tests
   • Arterial blood gas (ABG) analysis

3. Imaging:

   • CT Scan or MRI of the brain to rule out structural causes
   • EEG (Electroencephalography) to monitor seizure activity

4. Toxicology Screen:

   • To identify any drug intoxication or alcohol withdrawal

5. CSF Analysis:

   • If infection (e.g., meningitis) is suspected

---

Emergency Management

1. Initial Assessment:

   • Secure the airway (intubation if necessary)
   • Administer oxygen
   • Monitor vital signs (BP, HR, SpO2)
   • Establish IV access

2. First-line Treatment:

   • Benzodiazepines:
     • IV Lorazepam (0.1 mg/kg, max 4 mg/dose)
     • IV Diazepam or Midazolam if Lorazepam is unavailable

3. Second-line Treatment:

   • Anti-epileptic Drugs (AEDs):
     • IV Phenytoin (15-20 mg/kg)
     • IV Fosphenytoin or Valproic Acid

4. Refractory Status Epilepticus:

   • Requires ICU admission
   • IV anesthesia with Propofol, Midazolam, or Pentobarbital

5. Supportive Measures:

   • Correct metabolic derangements (e.g., glucose, electrolytes)
   • Treat underlying infections or other causes

---

Medical and Surgical Treatment

1. Medical Treatment:

   • Long-term AED therapy (e.g., Levetiracetam, Lamotrigine)
   • Address underlying conditions (e.g., stroke, metabolic imbalance)

2. Surgical Treatment:

   • Reserved for refractory epilepsy cases (e.g., lesionectomy, vagus nerve stimulation)

---

Nursing Interventions

1. During Seizure Activity:

   • Protect the airway and prevent aspiration (place patient in a lateral position)
   • Ensure safety by removing nearby sharp objects
   • Do not restrain the patient or place anything in their mouth

2. Monitoring:

   • Continuous monitoring of vital signs and seizure activity
   • Record seizure duration, type, and recovery

3. Administer Medications:

   • Administer prescribed benzodiazepines or AEDs
   • Monitor for side effects of medications (e.g., respiratory depression with benzodiazepines)

4. Patient Education:

   • Educate the patient and family on medication adherence
   • Discuss triggers and strategies to avoid them (e.g., sleep deprivation, alcohol)

5. Psychosocial Support:

   • Provide reassurance to the patient and family
   • Address any anxiety or fear about the condition

6. Post-Seizure Care:

   • Reassess neurological status
   • Ensure patient comfort and provide rest

7. Documentation:

   • Accurately document the episode, interventions, and patient response