Management of Status Epilepticus
John H. Menkes MD1
1 Private practice specializing in pediatric neurology in Beverly Hills, California
Status epilepticus is one of the few neurologic emergencies in the practice of pediatrics. A patient is considered to be in status when seizures occur so frequently as to prevent emergence from the postictal phase induced by one attack before the occurrence of the next.
There are four sequential aspects to the management of the patient in status: maintenance of vital functions, drug therapy to control the convulsions, assigning a cause for the condition, and lastly, prevention of further convulsions.
MAINTENANCE OF VITAL FUNCTIONS
A significant percentage of patients die in the course of status epilepticus, or shortly thereafter. Fatalities have ranged from 23% in all ages to 4% in an exclusively pediatric series. The physician treating the child in status should act promptly to maintain an adequate airway, prevent aspiration of mucus, and secure the child from injury induced by the violence of the convulsions. Hyperthermia and hypotension should be vigorously corrected. Whenever there is cyanosis, oxygen should be administered.
From experimental work we have learned that convulsions lasting longer than 20 to 30 minutes may induce brain damage. Several systemic factors acting singly or in concert are believed to be responsible. Hyperpyrexia and arterial hypotension have been singled out as inducing damage to nerve cells, particularly within the cerebellum.
