THE TREATMENT OF STATUS EPILEPTICUS

Abstract

Status epilepticus, though declining in frequency in recent years, is a medical emergency as well as a persistently difficult problem in balanced therapy. By its very nature it is likely to require the direct involvement of the family physician be he a pediatrician or a general practitioner. It may be useful to begin by defining and considering special aspects in relation to causes and age. Most convulsive seizures are self-limiting events terminating on their own accord before specific medical treatment need or can be rendered. For these, positioning to prevent aspiration of excessive secretions and vomitus and prevention of self-injuries is generally sufficient. Prying open clenched teeth for the insertion of time-honored tongue blades, pencils, or fingers has no place in modern medicine. These maneuvers are useless in the prevention of tongue biting (that will have occurred at the onset of the initial tonic phase), but may actually be harmful by dislodging loose teeth, and by initiating nociceptive stimuli that reflexly can prolong the tonic phase. Likewise excessive restraining of convulsing patients may faciitate bone injuries. The administration of drugs postictally is unnecessary in the majority of isolated seizures. Exceptions of course are prolonged or serial convulsions, or status epilepticus as discussed below, and those instances in which the convulsion has occurred because of failure in taking prescribed antiepileptic medication. The recent availability for quick appraisal of serum levels of antiepileptic drugs is a useful guide in this respect. Turning now to the definition of status epilepticus: official formulations such as an attack which is so prolonged or so frequently repeated as to constitute a definite lasting condition is open to some confusion.