#33 Seizures

Status epilepticus (SE) is a neurologic emergency much like an MI is a cardiac emergency and should be treated as such.⁠ From EEGs to medications, Mary Kay Bader, RN CCNS, talks us through both convulsive and non-convulsive SE.⁠

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Major Types of Seizures

  1. Generalized Seizures affect both hemispheres of the brain
  2. Focal Seizures affect one hemisphere of the brain but may progress to both hemispheres (a generalized seizure)

Status Epilepticus

Status Epilepticus (SE) is defined as a seizure that lasts over five minutes

  • Convulsant (CSE) seizures present with a tonic-clonic muscle jerking
  • Non-convulsant (NCSE) present with AMS, twitching

Why is SE a neurologic emergency?

SE can start causing neuron cell death within five minutes. However, SE that is sustained and poorly controlled for over 30 minutes has the highest morbidity and mortality.

Brain tissue damage occurs due to abnormal electric activity coupled with depletion of glucose and oxygen, which are consumed quickly during seizures.

Medications

1st line: Benzodiazepines because of their rapid onset are used to stop seizures

  • IV route: Lorazepam
  • IM, intranasal, or buccal: Midazolam
  • Rectal: Diazepam

2nd line: Antiseizure medications are administered with the goal of prevent recurrence

  • Levetiracetam
  • Fosphenytoin and phenytoin
  • Valproate

3rd line: Antiseizure medications that are administered for refractory SE, not preferred due to adverse reaction or limited research.

  • Phenobarbital
  • Lacosamide
  • Ketamine

What should you do if your patient seizes?

  • Call people to the room like you would a code
  • Ask one person to record events (i.e. seizure presentation, drugs administered, time)
  • Get a respiratory therapist in anticipation of intubation
  • Place the patient on telemetry as the medications that will be administered can effect cardiac rhythms
  • Check blood pressure
  • Check blood glucose
  • Draw labs
  • Place an EEG within 15 minutes to assess for non-convulsive seizures once convulsions have stopped