Download Status epileptics

Common Neurological Disease
Dr. Abdul-Monim Batiha,
Status epileptics
 is a life-threatening condition in which
the brain is in a state of persistent seizure.
Definitions vary, but traditionally it is
defined as one continuous unremitting
seizure lasting longer than 30 minutes ,
or recurrent seizures without regaining
consciousness between seizures for greater
than 30 minutes (or shorter with medical
intervention).
• The symptoms may be associated with tonicclonic, complexpartial, or absence seizures
• It is always considered a medical emergency.
• The mortality rate of status epilepticus is very
high (at least 20%), especially if treatment is not
initiated quickly.
• However, with optimal neurological care and a
good prognosis, the patient (even some
epileptics) in otherwise good health can survive
with minimal or no brain damage, and can even
avoid future seizures
Causes
• Only 25 percent of people who experience
seizures or status epilepticus have epilepsy.
• Stroke
• Intoxicants or adverse reactions to drugs.
• Insufficient dosage of a medication already
prescribed to the patient.
• Sudden withdrawal from a seizure medication
• Consumption of alcoholic beverages while on
an anticonvulsant.
• Dieting or fasting while on an anticonvulsant.
Causes
Common causes of newonset status epilepticus are:
 Brain disorders, such as:
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Meningitis
Encephalitis
Brain tumors
Abscess
Traumatic brain injury
 Sepsis
 Some autoimmune disorders
 Extremely high fever, especially in children
 Low glucose levels
 Eating disorders
Classification of Seizures
1. Generalized
 Involve both hemispheres; loss of consciousness;
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Classification of Seizures
2. Partial
Focal; involve one hemisphere
Classification of Seizures
Complex partial—altered level of
consciousness; with or without automatisms:
lip-smacking, swallowing, aimless walking,
verbalizations
diagnosis
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History taking
CT-scan
MRI
EEG
Epilepsy Monitoring Unit
Clinical management
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Benzodiazepines
Phenytoin
Carbamazepine and valproate
Barbiturates
General anesthetics
Nursing Management
The
nurse
initiates
ongoing
assessment and monitoring of
respiratory and cardiac function
because of the risk for delayed
depression of respiration and blood
pressure secondary to administration
of antiseizure medications and
sedatives to halt the seizures.
Nursing assessment also
includes monitoring and
documenting the seizure
activity and the patient’s
responsiveness.
The patient is turned to a side-lying
position if possible to assist in draining
pharyngeal
secretions.
Suction
equipment must be available because
of the risk for aspiration. The
intravenous line is closely monitored
because it may become dislodged
during seizures.
A person who has received long-term
antiseizure therapy has a significant
risk for fractures resulting from bone
disease (osteoporosis, osteomalacia,
and hyperparathyroidism), a side
effect of therapy. Thus, during
seizures, the patient should be
protected from injury using seizure
precautions and monitored closely.
No effort should be made to
restrain movements. The patient
having seizures can unintentionally
injure nearby people, so nurses
should protect themselves.
PATIENT EDUCATION
AND DISCHARGE PLANNING
■ Make the home environment safe, particularly in the
case of tonic-clonic epilepsy.
■ Assess for injury after each seizure.
■ Keep a log to record a description of the seizure and
postictal period, duration, time of day, severity, and
any new characteristics.
• Wear a Medic Alert bracelet.
• ■ Monitor serum antiepileptic drug levels
when appropriate.
• ■ Be aware of circumstances when emergency
treatment
Encephalitis
 Encephalitis is an acute inflammation of
the brain.
 A common cause of viral encephalitis in
humans is herpes (HSE).
 It can be caused by a bacterial infection such
as bacterial meningitis spreading directly to
the brain (primary encephalitis),
 or may be a complication of a current
infectious disease syphilis (secondary
encephalitis)
Symptoms
 Patients with encephalitis suffer
from fever, headache and photophobia with
weakness and seizures also common.
 Less commonly, stiffness of the neck can occur
with rare cases of patients also suffering from
stiffness of the limbs, slowness in movement and
clumsiness depending on which specific part of
the brain is involved.
 Neck rigidity may lead to a misdiagnosis of
meningitis, but treatment is the same.
 Other symptoms can include drowsiness and
coughing.
Diagnosis
 Examination of the cerebrospinal fluid obtained by
a lumbar puncture procedure usually reveals increased
amounts of protein and white blood cells with normal
glucose, (though in a significant percentage of patients,
the cerebrospinal fluid may be normal).
 CT scan often is not helpful, as cerebral abscess is
uncommon. Cerebral abscess is more common in
patients with meningitis than encephalitis.
 Bleeding is also uncommon except in patients
with herpes simplex type 1 encephalitis.
 Magnetic resonance imaging offers better resolution.
 EEG
Treatment
 Treatment is usually symptomatic.
 Antiviral or antibiotic
 In patients who are very sick, supportive
treatment, such as mechanical ventilation, is
equally important.
 Corticosteroids (e.g. methylprednisolone) are
used to reduce brain swelling and inflammation.
 Sedatives may be needed for irritability or
restlessness.
 Anticonvulsants are used to prevent seizures.
Meningitis
 Meningitis is inflammation of the protective
membranes covering the brain and spinal cord,
known collectively as the meninges.
 The inflammation may be caused by infection
with viruses, bacteria, or other microorganisms, and
less commonly by certain drugs.
 Meningitis can be life-threatening because of the
inflammation's proximity to the brain and spinal
cord; therefore the condition is classified as
a medical emergency.
Signs and Symptoms
 The most common symptoms of meningitis
are headache and neck stiffness associated
with fever, confusion or altered consciousness,
vomiting, and an inability to tolerate light
(photophobia) or loud noises (phonophobia).
 Sometimes, especially in small children,
only nonspecific symptoms may be present, such
as irritability and drowsiness.
 If a rash is present, it may indicate a particular
cause of meningitis; for instance, meningitis
caused by meningococcal bacteria may be
accompanied by a characteristic rash
Diagnosis
• lumbar puncture may be used to diagnose or
exclude meningitis.
• This involves inserting a needle into the spinal
canal to extract a sample ofcerebrospinal
fluid (CSF), the fluid that envelops the brain and
spinal cord.
• The CSF is then examined in a medical
laboratory.
Treatment
• The usual treatment for meningitis is the
prompt application of antibiotics and
sometimes antiviral drugs.
• In some situations, corticosteroid drugs can
also be used to prevent complications from
overactive inflammation.
Complications and Prevention
• Meningitis can lead to serious long-term
consequences such
as deafness, epilepsy, hydrocephalus and
cognitive deficits, especially if not treated quickly.
• Some forms of meningitis (such as those
associated with meningococci, Haemophilus
influenzaetype B, pneumococci or mumps
virus infections) may be prevented
by immunization