Seizures management

Status epilepticus is >5 minutes of continuous seizures or ≥ 2 discrete seizures between which there is incomplete recovery of consciousness.

If patient has a history of seizures,maintain ABCs,monitor vitalk signs,start oxygen if SPO2 <94%.

Check RBS.

If it is a first time seizure,send samples for MPS,UEC,HIV,urinalysis if pregnant or postpaturm.

If pregnant or postpaturm,load with IV magnesium sulphate 4gm diluted in 100ml NS over 15minutes.Continue with an infusion of 2gm/hr.

If patient is a known epileptic or has had >1 seizure,send samples for UECS,MPS,Urinalyusis if pregnant or postpaturm,antiepileptic drug(AED) levels as applicable.

If epileptic and non-compliant to medication,resume regular AED or if unknown,load PO/IV;phenytoin 20mg/kg OR Na Valproate 40mg/kg if on ARVS.

For all the above patients;

Patients with typical recurrent seizures related to previously treated epilepsy or eclamptic patients are unlikely to have lifethreatening structural lesions.These patients do not require MRI/CT SCAN.

An MRI/CTSCAN should be performed immediately when a provider suspects a serious structural lesion or;

• new focal deficits

• persistent altered mental status(with/without intoxication)

• Fever

•.Recent trauma

• Persistent headache

• history of cancer

• history of anticoagulation

• Suspicion of AIDS

• Patients who have recovered from a seizure and from whom no clear cause has been identified.

In addition patients with first time seizure ,emergent MRI/CT shoud be considered if any of the following is present:

• Age >40 years

• Partial-onset-seizure

🕯 Patients with reccurent seizure(prior history of seizures)emergent MRI/CT should be considered if any of the following is present:

• New seizure pattern or new seizure type

• prolonged post-ictal confusion or worsening mental status.

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