Status epilepticus
| Classification according to ICD-10 | |
|---|---|
| G41.- | Status epilepticus |
| G41.0 | Grand mal status
Status with tonic-clonic seizures |
| G41.1 | Petit mal status
Absence status |
| G41.2 | Status epilepticus with complex focal seizures |
| G41.8 | Other status epilepticus |
| G41.9 | Status epilepticus, unspecified |
| ICD-10 online (WHO version 2019) | |
As status epilepticus (in neurology often short status an exceptionally long-lasting are called) epileptic seizure or series of seizures called when the interval between the attacks is so short that the output state at the level of consciousness is no longer achieved and other body functions .
Status epilepticus can basically occur in all types of epileptic seizures. Depending on the type of seizure and the duration of the status, this can lead to severe damage and also be life-threatening.
A form of epilepsy in which there is an above-average tendency towards status epilepticus compared to other forms is Dravet syndrome .
features
Takes a single epileptic seizure in terms of a grand mal more than five minutes or a series of seizures or a seizure in the form of absence seizures or a partial seizures longer than 20 to 30 minutes or between a series of attacks, the awareness is not completely recovered, so it is a status epilepticus.
A status leads to a progressive, deepening disturbance of consciousness. The intervals between the individual attacks can be shorter. If left untreated, a status can become independent and thus persist for days.
causes
In addition to the presence of epilepsy, status epilepticus can also be triggered by other causes, for example by infections , withdrawal from drugs or medication in the case of corresponding dependency or by degenerative changes in the brain or due to overstimulation such as fast computer games, flickering lights or Sleep deprivation.
Complications
The status epilepticus is potentially life-threatening because, on the one hand, the physical strain, especially in the grand mal status, and on the other hand, the impairment of the control of the central nervous system can cause important bodily functions, such as the control of breathing , blood pressure and temperature, to fail . In addition, the long-lasting electrical discharges of the nerve cells can lead to massive brain damage in a status other than a "simple" epileptic seizure. The lethality of status epilepticus averages 10%, but varies significantly depending on the cause.
treatment
Attempts to hold the victim or push something between the teeth can cause serious injury or suffocation. Apart from securing the environment and observing the course of the seizure and its duration as closely as possible, inexperienced laypeople can not help the person affected. However, these observations are an important aid for the attending physician.
The status epilepticus is an emergency in which, regardless of whether an emergency medication e.g. B. was administered by the paramedic or not, an emergency doctor should always be notified. The emergency doctor must provide an initial intravenous treatment and arrange for the patient to be referred to a clinic quickly, which, if necessary, can ensure the escalation therapy described below. In the current treatment guidelines of the German Society for Neurology , a three-stage treatment scheme is recommended. High-dose iv administration of a benzodiazepine ( lorazepam , diazepam , clonazepam , midazolam ) is recommended as initial treatment . The best evidence is available for the administration of lorazepam, which in meta-analyzes was superior to the administration of diazepam. There are currently insufficient comparative data on the administration of other benzodiazepines in adult patients. If the status epilepticus cannot be broken with this treatment, the administration of phenytoin infusion concentrate via a separate IV line is recommended. Alternatively, or if the administration of phenytoin is not indicated, iv valproic acid , levetiracetam or phenobarbital are available. The intravenous administration of lacosamide is another choice of therapy . Like levetiracetam, lacosamide is not approved for the treatment of status epilepticus. As for some of the other options, there are no prospective studies on the efficacy and tolerability of these substances in status epilepticus. At the latest, if the status epilepticus has not been broken after an adequate dose of benzodiazepine and the administration of one of the substances mentioned here, further treatment must generally be carried out in the intensive therapy ward. The rapid use of the anesthetic anticonvulsants thiopental , midazolam or propofol is recommended here. If the status epilepticus cannot be broken by this either, only case reports or small case series are available with regard to the further therapeutic procedure . The following routes can be pursued (without any gradation in terms of content): ketamine , inhalation anesthetics such as isoflurane and desflurane , lidocaine , iv magnesium sulfate, brain stimulation, hypothermia, and epilepsy surgery.
Individual evidence
- ↑ a b DGN guideline status epilepticus in adulthood S2k, as of February 20, 2012.
- ↑ Classification and key clinical symptoms of status epilepticus on the website of an epileptologist at the Essen University Hospital .
- ^ H. Pockberger: Pathophysiology of the status epilepticus. Publication of the Austrian section of the International League Against Epilepsy on the Status Epilepticus as a PDF file .
- ↑ Prasad et al. Cochrane Database Syst Rev 2005; 4: CD 003723.
