STATUS EPILEPTICUS

SUSILO SISWONOTO
 Status Epilepticus
Epidemiologi
• 10% individu epilepsi akan mengalami minimal
sekali serangan SE dalam hidupnya
• 10% pasien mengalami serangan pertama
seizure unprovoked dengan SE
• Risk of recurrent SE:
– Lebih sering didapatkan dengan etiologi simptomatik
– Lebih jarang didapatkan pada kasus idiopatik atau
kejang demam
 Status Epilepticus

Definisi
• Bangkitan/seizure tunggal atau berulang
tanpa pulihnya kesadaran diantaranya yang
berlangsung lebih dari 30 menit (WHO)
 Status Epilepticus
Etiologi
• Idiopathic (24%) No precipitating event, pt is
neurologically and developmentally
normal
• Febrile (24%) Includes “febrile seizures” and
seizures in the setting of a febrile illness
• Remote Symptomatic (23%) Prior
neurological insult or developmental brain
malformation
• Acute symptomatic (23%)
• Progressive Degenerative (6%)
 Status Epilepticus
Acute Symptomatic Etiologies
• Vascular
– Stroke (Hemorrhagic > Ischemic)
– Subarachnoid Hemorrhage
– Hypoxic Ischemic Encephalopathy
• Toxic
– Cocaine and other sympathomimetics
– Alcohol withdrawal
– Various Medications (Isoniazid, TCA’s, various
chemotherapy agents)
– AED non-compliance or withdrawal
 Status Epilepticus
Acute Symptomatic Etiologies
• Metabolic
– Hyper or Hypo-Natremia
– Hypoglycemia
– Hypocalcemia
– Liver or Renal failure
• Infectious
– Meningoencephalitis
– Brain Abscess
• Trauma
• Neoplastic
 KLASIFIKASI SE

1.SE konvulsif(bangkitan umum tonik klonik)

2.SE non konvulsif
 Status Epilepticus
Treatment
• ABCD’s
– Airway: Risk of aspiration, suction to
bedside
– Breathing: Give supplemental O2
– C/V: Initial tachycardia giving way to
hypotension (especially when Benzos
or Barbiturates are given)
– Dextrose: Symptomatic hypoglycemia is
causing irreversible brain injury until
corrected
 Status Epilepticus
• History
– Fever, pre-existing epilepsy, trauma, baseline
AED’s and their dosing
• Physical Exam
– Signs of trauma, nuchal rigidity, end organ injury
– Subtle signs of seizures (tachycardia, pupil dilation
and hippus, nystagmus, irregular respirations)
• Work Up
– Lytes, glucose, AED levels, CPK, LFT’s, ABG,
NH3
– CT of brain
– LP (when stable) if indicated. Empiric antibiotics.
 Status Epilepticus
Anticonvulsant Therapy
• Diazepam 10 mg iv dapat diulang 10
menit, kecepatan pemberian 2 - (10
minutes)
• Pemberian phenitoin iv dengan dosis 15
-18 mg/kg bb, kecepatan pemberian 50
mg/mnt (10 to 30 minutes)
• Transfer ICU, pemberian propofol atau
thiopental (>30 minutes)
 Status Epilepticus

Benzodiazepine Therapy
• Lorazepam
– 0.1 mg/kg max: 4 mg/dose
– Has 8 hour effective t½
• Diazepam
– 0.3 to 0.5 mg/kg max: 10 mg/dose
– Fat-soluble so pr dosing possible
– Diastat (Dosing about double that of IV)
 Status Epilepticus
Long-Acting Anticonvulsant Therapy
• Phenytoin
– 20 mg/kg over 20 minutes (regardless of
weight)
– C/R monitor during load
– No dextrose in line
– Extravasation injuries are severe
 Status Epilepticus

Long-Acting Anticonvulsant Therapy

• Phenobarbital
– 20 mg/kg over 20 minutes
– Watch for respiratory suppression
(especially if the patient has received
Benzodiazepines)
– Watch for hypotension
– Good for Febrile Status Epilepticus
 Status Epilepticus
Refractory Status
• Secure airway
• Transfer to ICU
• Extra lines for hypotension treatment
• EEG Monitoring (electrical-clinical
dissociation)
• Medications
– Pentobarbital
– Other agents (Midazolam drip, Propofol,
Lidocaine, inhalation anesthetics, other AED’s)