Pediatric Status Epilepticus
January 10, 2013 · 1 Comment
Seizures occur due to rapid abnormal electrical discharges produced by cerebral neurons. This presents as involuntary deficits of consciousness and motor activity. Status epilepticus, also called acute prolonged seizure activity, is a series of generalized seizures that occur without full recovery of consciousness between attacks and lasts longer than 30 minutes. Status epilepticus is considered as a medical emergency. The continuous muscular contraction demands a massive metabolic requirement (utilization of oxygen, glucose, and energy) and can therefore hold up respirations. Occurrence of respiratory arrests and incidence of hypoxia is possible during attacks. This condition is concurrent and continuous, thus the risk of having brain damage is high and can be very fatal. In the United States, it was documented that 70% of children less than 1 year who are diagnosed with epilepsy manifest status epilepticus as the initial symptom. On the other hand, 20% of children with epilepsy have status epilepticus, 5 years after the diagnosis.
Causes
- Withdrawal from anti – seizure medication
- Fever
- Concurrent infection
- Birth injury
- Congenital abnormalities
- Febrile convulsions
- Metabolic disorders
- Tumors
- Trauma
- Toxins
Diagnosis
- Electrolyte studies
- Calcium levels
- Magnesium levels
- Blood glucose levels
- White Blood Count
- Arterial Blood Gas Analysis
- CT Scan (especially if there’s trauma)
- Electroencephalography
- Lumbar puncture
Medical Management
- Treatment centers on stopping the seizure episodes immediately. This is to ensure adequate brain oxygenation and prevent hypoxia and anoxia. The health team ensures that the airway and oxygenation is supported. In cases of unresponsiveness, endotracheal tube insertion is performed.
- Isotonic Intravenous infusion and glucose is indicated.
- Medication are given intravenously, these medications stop seizures:
- Diazepam
- Lorazepam
- Fosphenytoin
- To maintain a seizure free state, medications such as phenytoin and phenobarbital are given.
- Blood samples are taken to keep an eye of electrolyte levels, glucose levels, and phenytoin levels.
- EEG is performed to decipher seizure activity.
- Neurovital signs are ardently monitored and documented.
Nursing Management
- The nurse’s role is to ensure adequate assessment and strict monitoring of the child. Controlling the seizures and stopping it eventually is the focus of the treatment and so, nurses should be assertive in spotting various respiratory and cardiac presentations that may put the child at risk, that way, medical intervention could be done immediately and further complications be avoided.
- Seizure monitoring and documentation is also necessary, this will act as a baseline for doctors as well as a guide in determining the progress of the patient while on medication.
- Seizures can cause aspiration and asphyxiation, therefore, nurses should place patients into side lying position to facilitate drainage. A suction machine should be ready at the bedside at all times.
- Securing the area from seizure attacks is very important. Seizure precaution should be observed at all times.
Experience includes medical-surgical and critical care nursing and roles such as clinical development specialist, and simulations coordinator. Rita is a member of Sigma Theta Tau, the International Honor Society of Nursing; NNSDO, INACSL, Horizons at AACN. She is currently pursuing a MN in Nursing Education. Rita has also served as adjunct faculty for the Associate’s Degree in Nursing and has been a contributor for a wide array of policy and procedure books.
It is awful to witness status epilepticus—a condition I personally witnessed several times during the 15 years when my husband was ill with a brain tumor. That’s when I first started researching non-drug treatments for seizures. One of the treatments I discovered was the Ketogenic Diet—a diet which has been known to help children with seizures since the 1920s, at hospitals such as the Mayo Clinic and Johns Hopkins. (Today there are over one hundred hospitals worldwide that administer the diet.)
I also learned a tremendous amount about this high-fat, low-carb, low-protein diet while doing the research for my book, “Honest Medicine,” which features four lifesaving treatments many doctors don’t know about, including the Ketogenic Diet. This diet has lots of research behind it, as well as what I like to call “patient-based evidence”—i.e., hundreds of thousands of children who have been helped by the diet. I am happy to share with any of your readers studies from the 1920s on, showing that the diet is effective. The best part of the diet (as opposed to anti-seizure meds) is that, in addition to being less toxic than drugs, most children for whom it is successful (that’s 67% of children who are put on it) only have to be on the diet for around two years before they are able to return to a “normal” diet.
Please feel free to write to me at Julia at HonestMedicine.com if you’d like me to send you the studies I mentioned above. Also, there is a tremendous amount of information about the diet at CharlieFoundation.org.
Thanks for letting me post here. I hope my post can help lots of people.
Julia Schopick (HonestMedicine.com)