Diagnosis and treatment of status epilepticus

The article is professionally consulted by Specialist Doctor I Do Van Manh - Emergency Department - Vinmec Ha Long International Hospital.

Status epilepticus is the most severe and extreme type of epilepsy, causing a stroke or brain inflammation. For people with epilepsy, they often have similar seizure lengths and will usually stop. However, seizures in status epilepticus do not stop or have no recovery period.

Muscle twitching involves abnormal electrical activity in the brain that affects both the brain and the body. Seizures can be caused by many things, such as a high fever, a brain infection, abnormal levels of sodium or blood sugar, or a head injury. If the person has epilepsy, the person may have multiple seizures.
In case the seizure lasts more than 5 minutes or there is more than 1 seizure in about 5 minutes, but consciousness does not return to normal between seizures, it is called status epilepticus.
This is an emergency because it can lead to permanent brain damage or death. Without prompt medical attention, doctors are less likely to stop a seizure with medication, and the risk of death increases as the seizure lasts.
Status epilepticus is very rare, most people with epilepsy rarely experience it. Status epilepticus is divided into 2 types:
Status epilepticus. This is an epileptic state that is accompanied by convulsions, so it can easily lead to injury. Symptoms include sudden jerking, muttering, drooling, and rapid eye movements. Nonconvulsive status epilepticus. Symptoms include confusion or looking like the person is dreaming, being unable to speak, and unusual behavior.

Status epilepticus can be caused by a number of factors and conditions that trigger status epilepticus, but sometimes it can happen without a cause. Possible causes of status epilepticus include:
Epileptic syndrome : People with serious seizure disorders, such as Rasmussen syndrome, Rett syndrome, Lennox-Gastaut syndrome and Dravet syndrome are those prone to seizures. Brain damage: People with extensive damage to the cerebral cortex - this is the area of ​​the brain most likely to cause seizures and are more likely to have status epilepticus than people with localized damage to one area of ​​the brain. Brain. Prenatal hypoxia, cerebral palsy, head trauma, and severe blood loss leading to severe brain damage can increase the likelihood of epilepsy, even after many years of trauma it is still possible to have a seizure. Brain Tumors: Tumors in the brain and brain cancer can produce seizures and status epilepticus, especially when tumors are large or numerous. Electrolyte disturbances due to blood loss, dehydration, malnutrition, drug overdose can all cause electrolyte imbalance and lead to convulsions and status epilepticus. Alcohol or stimulant overdose: Alcohol and drugs (cocaine, methamphetamine, and heroin) can both cause brief seizures or status epilepticus. Encephalitis: A brain infection can cause severe and long-lasting status epilepticus, however this cause is uncommon.

Diagnosis of status epilepticus is through clinical observation, but most commonly an electroencephalogram (EEG), brain scan, or lumbar puncture to confirm the diagnosis.
EEG: Because the clinical symptoms of status epilepticus and some other conditions can be similar, it is often necessary for the physician to analyze the EEG to distinguish between seizures and other conditions. such as stroke and brain disease. Brain scan: Computed tomography (CT) or magnetic resonance imaging (MRI) scans of the brain to determine the cause of seizures and identify conditions such as stroke, brain tumor, or inflammation in the brain. Cerebrospinal fluid (CSF) puncture: If the patient is suspected of having an infection, the doctor will collect cerebrospinal fluid by taking a sample of the spinal fluid for testing. Diagnosis of status epilepticus and determining its cause is important because status epilepticus requires a different treatment regimen than other conditions with similar symptoms.

Status epilepticus is a medical emergency, where the person can die from injury from a fall and convulsion, suffocation, or as a result of a prolonged seizure. Seizures can cause brain damage leading to more severe seizures, an increased predisposition to status epilepticus and cognitive impairment. Some specific treatment for status epilepticus:
First aid at home.
If you are treating a person with a seizure at home, you must:
Make sure the person's head does not hit other objects. Moving the sick person to an area can be dangerous. Perform chest compressions if the patient's heart stops breathing. Use pre-prescribed medications to prevent muscle twitching, such as midazolam or diazepam. Call an ambulance or take the patient to the nearest medical facility if:
It is the patient's first seizure; The seizure lasts more than five minutes; tonic-clonic seizures occurring in succession without a recovery interval in between; Injured by convulsion. At the Medical facility
The American Epilepsy Association made the following recommendations for the treatment of status epilepsy:
First-line drugs for status epilepticus include: Intramuscular midazolam, intravenous Lorazepam, intravenous diazepam, rectal diazepam; If the above drugs are not effective, medical staff can use the following drugs: intravenous valproic acid, intravenous fosphenytoin. These drugs work quickly, and their effects usually don't last more than a few hours. When status epilepticus is triggered by other medical conditions, after the seizure is controlled, the patient needs to treat the cause, such as:
Treatment of infection Treatment of electrolyte and metabolic disorders Treatment using steroids to reduce edema due to tumor Tumor removal surgery Specialist Doctor I Do Van Manh has more than 10 years of experience in the field of Intensive Care - Anti-toxic. He used to be the Deputy Head of the Intensive Care Unit at Quang Ninh General Hospital before working at Vinmec Ha Long International Hospital.
Status epilepticus, if prolonged, will cause brain damage and cause many other dangerous complications. You should thoroughly treat the related diseases that cause status epilepticus. To register for examination and treatment at Vinmec International General Hospital, you can contact the nationwide Vinmec Health System hotline, or register online HERE.
Reference source: webmd.com; hopkinsmedicine.org
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