Pediatric Status Epilepticus

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.

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