What Is Involved in the Management of Status Epilepticus in Children?

Epilepsy status (SE), or epilepsy status, is the incomplete recovery of consciousness between frequent seizures and frequent recurrence, or seizures that do not stop on their own for more than 30 minutes. Prolonged seizures, if not treated in time, can cause irreversible brain damage due to high fever, circulatory failure or neuronal excitotoxicity damage, and the disability and mortality are high. Therefore, epilepsy is a common emergency in internal medicine. A variety of seizures can occur in a persistent state, but tonic-clonic persistent state is the most common clinically. Generalized seizure status (SE) is often accompanied by varying degrees of consciousness and motor dysfunction. In severe cases, there is a manifestation of cerebral edema and increased intracranial pressure.

Basic Information

English name: status epilepticus
Visiting department: Pediatrics
Multiple groups: Children, youth
Common locations: brain

Common causes: Febrile seizures, sudden withdrawal of antiepileptic drugs, irregular medication, severe lack of sleep or intermittent infection, etc.
Common symptoms: General tonic-clonic seizures reoccurring, disturbance of consciousness (coma) with high fever, side twitching, mild lethargy to stiffness, coma and urinary incontinence, etc.

Causes of status epilepticus

1. Febrile seizures account for 20% to 30% of pediatric SE.

2. Mainly occurred when children with epilepsy abruptly withdrew antiepileptic drugs, took irregular medications, severely lost sleep or had occasional infections.

3. Various causes of seizures in acute diseases can cause symptomatic SE.

Clinical manifestations of status epilepticus

1. Persistent state of generalized seizures

Generalized tonic-clonic seizures (GTCS) persistence: is a clinically dangerous and dangerous state of epilepsy. Tonic-clonic seizures occur repeatedly, with disturbances of consciousness (coma) accompanied by high fever, metabolic acidosis, hypoglycemic shock, electrolyte disturbances (hypotension Potassium, hypocalcemia, etc.) and myoglobinuria, etc., multiple organ failure such as brain, heart, liver, lungs, etc. can occur, autonomic nerves and vital signs change.

2. Persistent tonic seizures

It is more common in children with Lennox-Gastaut syndrome, showing different degrees of disturbance of consciousness, with occasional tonic or atypical absence, seizures, etc.

3. Persistent state of clonic seizures

Shows that clonic seizures last longer with confusion and even coma.

4. Persistent state of myoclonic seizures

Myoclonus is mostly focal or multifocal manifestations of rhythmic repetitive myoclonic seizures. The muscles are beating like twitches, and they are unconscious for several hours or days. Patients with idiopathic myoclonic seizures (benign) rarely experience epilepsy. Late-stage severe organic encephalopathy such as subacute sclerosing panencephalitis and familial progressive myoclonic epilepsy are more common.

(1) Simple myoclonic state seen in children with absence and tonic-clonic seizures ;

(2) Symptomatic myoclonic state is more common, often accompanied by degenerative encephalopathy such as Ramsay-Hunt myoclonic cerebellar coordination disorder, progressive myoclonic epilepsy such as renal encephalopathy, pulmonary encephalopathy and toxic encephalopathy .

5. Persistent state of absence

The level of performance consciousness is reduced, and even only the performance of reactive learning is decreased. The clinic should pay attention to recognition.

6. Persistent seizures

Persistent state of pure partial motor seizures: showing part of the body such as facial or mouth twitching, continuous twitching of individual fingers or unilateral limbs for hours or days, after the termination of the unconscious episode, Todd paralysis can be left at the site of the attack, and it can also be expanded For secondary generalized seizures.

7. Peripheral lobular epilepsy

Also known as psychomotor epilepsy, it often shows disturbance of consciousness (fuzziness) and mental symptoms, such as reduced activity, sluggishness, loss of attention, poor orientation, silence or single tone, and anxiety, fear, irritability, hallucinations Delusions wait for days to months and are common in temporal lobe epilepsy.

8. Lateral convulsions with hemiparesis

It usually occurs in young children, showing side seizures. Patients are usually conscious, with transient or permanent ipsilateral limb paralysis after the attack.

9. Persistent state of autism

A small number of patients present with autoimmune disorder, and the disturbance of consciousness can range from mild drowsiness to stiffness, coma, and urinary incontinence. If untreated, systemic seizures often occur, which can last for several hours to several days, or even half a year.

10. Neonatal epilepsy status

The performance is diverse, atypical, mostly slight tics, strange tonic movements of the limbs, often from one limb to another, or half body tics, apnea during the attack, and unconsciousness.

Epilepsy status check

Laboratory inspection

(1) Routine blood test can exclude symptoms or persistent state caused by infection or hematological diseases.

(2) Blood biochemical examination can exclude hypoglycemia, diabetic ketoacidosis, hyponatremia, and chronic liver and kidney insufficiency.

2. Auxiliary inspection

(1) Routine EEG, video EEG and dynamic EEG monitoring can display epilepsy wave patterns such as sharp wave, spike wave, spike-slow wave, spike-slow wave, etc., which is helpful for the diagnosis of seizures and epilepsy.

(2) Electrocardiogram examination Excludes large-scale myocardial infarction and various types of arrhythmia leading to extensive cerebral ischemia and seizures after hypoxia.

(3) Chest X-ray examination can rule out severe pulmonary infections leading to hypoxemia or respiratory failure.

(4) Other CT and MRI examinations of the head are available when necessary.

Diagnosis of status epilepticus

According to the history of epilepsy, clinical characteristics, routine or video EEG examination, etc. GTCS can only be diagnosed during the onset of sustained state of seizures. Partial seizures can be seen in local persistent motor seizures for hours or days, unconscious disturbances. Persistent state of limbic epilepsy and persistent state of autonomic disorders are both conscious and can be accompanied by mental illness. Disorganized and so on.

Differential diagnosis of status epilepticus

Partial epilepsy needs to be distinguished from transient ischemic attack (TIA). TIA can appear paroxysmal numbness, weakness, etc. without conscious disturbance. It is more common in middle-aged and elderly people, often with hypertension, cerebral arteriosclerosis and other brains. Stroke risk factors; epilepsy status should be distinguished from snoring and organic encephalopathy. Medical history and EEG are important basis for differentiating.

Treatment of status epilepticus

Commonly used drugs

(1) Diazepam (Diazepam) is the drug of choice for adults or children with various types of epilepsy.

(2) 10% chloral hydrate plus the same amount of vegetable oil to retain the enema.

(3) Clonazepam (clonazepam) is 5 times more effective than diazepam and is effective for all types of epilepsy .

(4) Lauraazepam (chloroxylazepam ) is 5 times stronger than diazepam.

(5) Isoprenebarbital (isoprenebarbital sodium) is injected intravenously at a rate not exceeding 0.05 g / min until the onset is controlled.

(6) Lidocaine is used for those who do not have a stable injection.

(7) Phenytoin (sodium phenytoin) can quickly pass through the blood-brain barrier and quickly reach an effective concentration in the brain with a loading dose. It has no respiratory depression and reduced arousal side effects, and it is especially effective for GTCS sustained state.

(8) Sodium valproate (valproic acid) Sodium valproate (Derbagin) can quickly terminate certain states of epilepsy, such as the state of partial seizures.

(9) Phenobarbital It is mainly used for maintaining medication after epilepsy control. After controlling seizures with diazepam, phenobarbital can be continued.

(10) Paraaldehyde has a strong effect and should not be used in patients with respiratory diseases.

If none of the above methods can control the seizure, anesthesia can be given by intravenous injection of thiopental sodium or ether inhalation.

2. Symptomatic treatment

(1) Prevention and treatment of cerebral edema A rapid intravenous infusion of 20% mannitol, or a 10-20 mg intravenous infusion of dexamethasone can be used.

(2) Controlling infections To prevent patients from inhaling during the onset of seizures, antibiotics may be used as appropriate to prevent complications.

(3) Relevant inspections Examine blood glucose, electrolytes, arterial blood gas, etc., if possible, EEG monitoring is available.

(4) Cooling down, correcting metabolic disorders and ensuring nutrition High fever can physically reduce the temperature and correct metabolic disorders such as hypoglycemia, hyponatremia, hypocalcemia, hypertonic state and hepatic encephalopathy, and correct water, electrolyte and acid-base balance disorders And given nutritional support treatment.

Prognosis of status epilepticus

The incidence of persistent epilepsy in epilepsy patients is 1% to 5%, and the mortality rate is still as high as 13% to 20%. Therefore, full attention should be paid to its diagnosis and management.

Prevention of status epilepticus

Prevention of epilepsy is very important. Preventing epilepsy involves not only the medical field, but also the concern of the whole society. Prevent the occurrence of epilepsy; control its seizures; reduce the adverse psychological effects of epilepsy on patients.