Diagnosis and Treatment of Status Epilepticus (Abstrak)
Content
DIAGNOSIS AND TREATMENT OF STATUS EPILEPTICUS Suryani Gunadharma SpS(K) M. Kes
Status Status epilep epileptic ticus us (SE) (SE) is a term term used used to descr describe ibe a prolo prolonge nged d and self selfsustaining seizure seizure , it is a neurological neurological emergency emergency that reuires reuires prompt diagnosis diagnosis and treat treatmen mentt . !elay !elay associ associate ated d "ith "ith a highe higherr li#eli li#elihoo hood d of poor poor resp respons onse e to treatment and "orse outcome. !e$nition of Status epilepticus epilepticus itself is %& %& seizure that persists persists for a su'cient length of time or is repeated freuently enough that recoery bet"een attac#s does not occur (*+&E,). /is# of a seizure becoming self-sustaining increases as the duration duration reaches reaches 01 min, duration duration of "hat is accepted accepted as SE has been shrin#ing shrin#ing progressiely from 23 to 1 min. Etiol Etiologi ogies es of SE class classi$e i$ed d as4 acute acute sympto symptomat matic, ic, remot remote e sympto symptomat matic, ic, progressie symptomatic or idiopathic5cryptogenic. &cute symptomatic causes are the most common etiology (67829 of all SE), "hich stro#e is the leading cause, other common etiologies are lo" antiepileptic antiepileptic drug (&E!) leels. :lassi$c :lassi$cation ation of SE consiste consiste of :onulsi :onulsie e SE (:SE), (:SE), ;onconu ;onconulsie lsie SE (;:SE) and the boundary syndromes such as in epileptic encephalopathies. :linical course course of :SE are *mpending *mpending status status epilepti epilepticus, cus, Establis Established hed status status epileptic epilepticus, us, /efractory status epilepticus epilepticu s and Super-refractory Super-refractory Status Epilepticus . Mana Manage geme ment nt of SE star startt form form esta establ blis ish h the the diag diagno nosi sis s of impe impend ndin ing g or establis established hed SE on clinical clinical grounds grounds alone, alone, diagnosi diagnosis s and management management of medical medical complicat complications ions,, and preent preention ion of neuronal neuronal in<ury in<ury.. /ectal /ectal diazepam diazepam is safe and e=ectie e=ectie for the pre hospital hospital managemen management. t. *mpending *mpending SE, is easily easily bloc#ed bloc#ed by drugs that increase inhibition or reduce e>citation, the patient needs a high-dose anticonulsants anticonulsants *.? "ith a short short elimination elimination half-life. half-life. @o"eer, once once self-sustaining self-sustaining status epilepticus is established, established, it is easily stopped by only a fe" drugs, all of "hich directly directly or indirec indirectly tly inhibit inhibit glutamate glutamatergi rgic c neurotra neurotransmi nsmissio ssion. n. ;M!& bloc#er bloc#ers s remain highly e'cient, een in late SE. /efractory /efractory status epilepticus is de$ned by the failure of adeuate amounts of t"o intraenous drugs to stop seizures, general anaesthesia should be gien as soon as possible.
Key"ordA Status epilepticus
!iagnosis
Breatment
C&S*: D/*;:*D+E F EEG
ED*+EDB*F/M !*S:@&/GES
Status Status epilep epileptic ticus us (SE) (SE) is a term term used used to descr describe ibe a prolo prolonge nged d and self selfsustaining seizure seizure , it is a neurological neurological emergency emergency that reuires reuires prompt diagnosis diagnosis and treat treatmen mentt . !elay !elay associ associate ated d "ith "ith a highe higherr li#eli li#elihoo hood d of poor poor resp respons onse e to treatment and "orse outcome. !e$nition of Status epilepticus epilepticus itself is %& %& seizure that persists persists for a su'cient length of time or is repeated freuently enough that recoery bet"een attac#s does not occur (*+&E,). /is# of a seizure becoming self-sustaining increases as the duration duration reaches reaches 01 min, duration duration of "hat is accepted accepted as SE has been shrin#ing shrin#ing progressiely from 23 to 1 min. Etiol Etiologi ogies es of SE class classi$e i$ed d as4 acute acute sympto symptomat matic, ic, remot remote e sympto symptomat matic, ic, progressie symptomatic or idiopathic5cryptogenic. &cute symptomatic causes are the most common etiology (67829 of all SE), "hich stro#e is the leading cause, other common etiologies are lo" antiepileptic antiepileptic drug (&E!) leels. :lassi$c :lassi$cation ation of SE consiste consiste of :onulsi :onulsie e SE (:SE), (:SE), ;onconu ;onconulsie lsie SE (;:SE) and the boundary syndromes such as in epileptic encephalopathies. :linical course course of :SE are *mpending *mpending status status epilepti epilepticus, cus, Establis Established hed status status epileptic epilepticus, us, /efractory status epilepticus epilepticu s and Super-refractory Super-refractory Status Epilepticus . Mana Manage geme ment nt of SE star startt form form esta establ blis ish h the the diag diagno nosi sis s of impe impend ndin ing g or establis established hed SE on clinical clinical grounds grounds alone, alone, diagnosi diagnosis s and management management of medical medical complicat complications ions,, and preent preention ion of neuronal neuronal in<ury in<ury.. /ectal /ectal diazepam diazepam is safe and e=ectie e=ectie for the pre hospital hospital managemen management. t. *mpending *mpending SE, is easily easily bloc#ed bloc#ed by drugs that increase inhibition or reduce e>citation, the patient needs a high-dose anticonulsants anticonulsants *.? "ith a short short elimination elimination half-life. half-life. @o"eer, once once self-sustaining self-sustaining status epilepticus is established, established, it is easily stopped by only a fe" drugs, all of "hich directly directly or indirec indirectly tly inhibit inhibit glutamate glutamatergi rgic c neurotra neurotransmi nsmissio ssion. n. ;M!& bloc#er bloc#ers s remain highly e'cient, een in late SE. /efractory /efractory status epilepticus is de$ned by the failure of adeuate amounts of t"o intraenous drugs to stop seizures, general anaesthesia should be gien as soon as possible.
Key"ordA Status epilepticus
!iagnosis
Breatment
C&S*: D/*;:*D+E F EEG
ED*+EDB*F/M !*S:@&/GES
