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.
- If seizure persist: Use phenobarbitone or phenytoin
- 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.