You’re at a Taylor Swift concert and Tay Tay is killing it – the costumes, the dances, and the oh-so-catchy pop singles. Taylor is about to start performing your favorite Taylor Swift single “Shake It Off”. The performance starts off with a wicked light show. Everyone’s into it. One audience member seems a little TOO into it. At first, you thought he was just busting out some new dance movies. But then you notice he’s on the ground and not responsive. His gaze is deviated. His limbs are violently contracting.
You accompany him with EMS to Kings County Hospital.
What is the definition of Status Epileptics?
A seizure lasting 5 minutes or more or multiple seizures without recovery of consciousness.
What medications would you want to try?
Step 1: A benzodiazepine
- Lorazepam IV (preferred) or IM – the drug of choice in status epilepticus. It has a slightly slower onset of action than midazolam but also a longer duration of action and is associated with fewer seizure recurrences.
- Diazepam IV
Step 2: Load with antiepileptic
- Fosphenytoin – preferred
- Valproic acid
- Levetiracetam
Step 3: If all else fails, sedate and intubate
- Propofol drip
- Midazolam drip
After administering lorazepam and fosphenytoin, the movements stop, and gaze returns your normal. Your patient starts speaking, albeit incoherently. Congratulations! You stopped his seizure! However, while performing a complete examination, you notice that he’s not moving his right arm.
What do you think is going on? Should you call a stroke code?Nope. This is Todd’s paralysis or postictal paralysis. This usually improves after 48 hours.
After speaking with the family, you realize this is the patient’s first seizure. To CT or not to CT?
American Academy of Neurology recommends performing a CT if brain lesion is suspected or the patient is greater than 40 years old.
Your workup is negative for any clear cause of seizure. Do you send him home on anti-epileptics?
No anti-epileptic is required for first time seizure but he should follow up with neurology!
By Karen Ta
References
Remember, the most recent evidence and what we do in practice may not always be the right answer on the exam. Frustrating, I know, but shake it off!
Kylie Birnbaum
Latest posts by Kylie Birnbaum (see all)
- Save of the Month – Cardiac Tamponade - July 13, 2017
- Homer’s Hepatic Board Review: Hepatic Encephalopathy - May 23, 2017
- Venomous Land and Marine Animals, Poisonous Plants and Heat Stroke - April 20, 2017
0 Comments