STATUS EPILEPTICUS

Clinical Features

A succession of seizures without regaining consciousness between attacks or one prolonged convulsion lasting 30 minutes or more.

Status epilepticus can occur with partial, complex partial, absence, tonic-clonic, or clonic seizures and may result in respiratory embarrassment with cyanosis and hypoglycaemia.

Management

The following is recommended in stabilizing the child with status epilepticus:

  • For the airway and breathing:
    • Establish the airway.
    • Give oxygen.
    • Provide ventilation.
  • With regard to circulation and disability
    • Establish intravenous access.
    • Give 10% dextrose 5ml/kg.
    • Give diazepam intravenously or rectally.

Management – Pharmacological

  • In the first 5–15 minutes:
    • Give diazepam: 0.2–0.5mg/kg IV over 1– 3 minutes or 0.5mg/kg rectally (max 10mg in 1–3 years and 15mg in 3–15 years). Repeat after 5–10 minutes if not controlled.
  • In the next 15–45 minutes:
    • If seizure persist: Use phenobarbitone or phenytoin
      • Phenobarbitone: Loading dose 15–20mg/kg IV in 5 minutes.
      • Rate of infusion not exceed 1mg/kg/min.
      • Additional 5mg/kg/dose can be repeated every 15–30 minutes to maximum of 30mg/kg.
      • IV Phenytoin (with glucose-free solution). Loading dose 15–20mg/kg. Infusion not to exceed 1mg/kg/minute.
  • In the next 45–60 minutes:
    • If all these do not control the convulsion, or severe respiratory depression results from the drugs, child needs ICU care where ventilation can be done.
    • When patient is stable look for the cause and treat as needed.