Status Epilepticus
Dr. Esther Tsang
Sept 2011
Case 1
 A 16 year old young boy was brought in at 2am by his friends
due to a ‘seizure’.
 They came from a night club and according to his friends, he
had a mild fever in the morning.
 What points in the history should you ask for to support a
diagnosis of a seizure?
 What other history would you ask for based on this
background history?
 What could be the possible causes of seizure in this
gentleman?
 When you examine him, he appears somnolent.
 He is arousable, able to say his name, confused, obeys
commands, moving all four limbs.
 What is his GCS?
 As you examine him, you notice that his breath reeks of
alcohol. Then, he looses consciousness, has jerky movements
of his upper limbs and lower limbs, and turns blue.
 What do you do now?
 What are your options if you are unable to secure IV access?
 The seizure self aborts after 2 mins. He regains his colour and
breathing returns to normal.
 You note that his neck is rather stiff.
 What would be your working diagnosis now?
 What investigations would you want to order and why?
 As you are writing up the orders, he has another seizure.
 This time, he does not wake up after 5 mins.
 His breathing is laboured.
 The medical officer in casualty tells you that his SpO2 was
88%, BP 130/70 mm Hg, HR 120, T 38°C.
 So, is this status epilepticus?
 How do you define status epilepticus?
 When do you decide to intubate this patient and why?
 How would you manage this patient now?
 What medications should you order and how to you start it?
 What are the second line medications should the first one fail o
control the seizures?
 The casualty MO suggests starting him on IV Thiamine prior to
a dextrose drip. Do you think this is wise? Why?
 Your medications fail to control the seizures, and he develops
another 2 seizures.You decide to intubate him and refer him
to ICU.
 Describe what medications you would give prior to
intubation.
 Describe the methods used to place the ETT correctly.
 The patient is then sent to ICU.
 The ICU MO wants to know how the anti-epileptics should
be served?
 Are there any drug interactions between the antiepileptics?
 After being treated 5 days in the ICU, your patient is now
awake, and alert. He is ready to be discharged to the general
ward.
 During your ward rounds, he asks you the following
questions.
 Does he have to take the anti-epileptic medications
permanently?
 What are the side effects of the medications?
 What are the symptoms of toxicity of the medications?
 Can he drive?