Case 3.2 Status Epilepticus

Mrs. Dey reported she had been extremely sick with the anti-seizure medications and her primary care advised her to stop the current medication and go into the hospital. She was hospitalized overnight in observation and Dr. Hardy requested she come into his office the following Monday, September 11, 2017. Due to the unexpected appointment, I had a scheduling conflict and my colleague Laurie Wawrzynaik RN, BSN, MA, attended.

Fifteen month old Jacob is brought seizing into our small rural emergency department by ambulance. He has been having generalised tonic clonic jerking movements and unresponsiveness for the past twenty-five minutes. He is accompanied by his very concerned mother. Jacob is immediately designated a category one triage as he is unresponsive, his life is in immediate danger as is having an ongoing and prolonged seizure. A Glasgow coma scale less than eight (his is three) means he is not able to protect his airway. The provisional diagnosis given to Jacob of generalised convulsive status epilepticus (SE) is a serious and often life threatening emergency as it can compromise the airway leading to hypoxia causing neurons to die leading to potential permanent brain damage.

Tony is a single, 50 year old Caucasian male still living with his mother and has one child which is a daughter 6 years old from a previous relationship in the past. He has never been married and currently not able to drive because of his seizure disorder because in the state of North Carolina he has to be seizure free for 1 year and approved by his family physician to legally drive. He relies on public transportation, friends and his mother in getting different places, such as going to the doctor, and visiting with his daughter. He has supervised visit with his daughter every other weekend due to the safety issues concerning his seizure disorder. Tony cannot be left alone because he does have a history of having seizures while no one is around

Epilepsy is a medical ailment in which nerve cell activity in the brain is disturbed, causing seizures. Epilepsy consists of many levels of severity; there are staring spells on the lower end, and Grand Mal seizures on the higher end. Cheyenne is on the lower end with staring spells, memory loss, and involuntary talking it’s called Partial Onset Seizures; she has the potential that it can have it turn into Grand Mal seizures at any point in her life. On the path to discovering her epilepsy, it changed her and her family’s lives forever.

It is significant to treat an individual with status epilepticus as soon as possible. One study indicated that 80 percent of folks in status epilepticus who received medicine within 30 minutes of seizure onset ultimately stopped having seizures, while only 40 percent recovered if two hours had passed before they received medicine. The following medicines may be

The patient is a 53-year-old African American female who was recently hospitalized from 1/19 -1/22, had a complete workup for seizure disorder, was discharged home and she represented to the ED several times on the 23rd complaining of seizures. She present after having a single isolated seizure which lasted 20 minutes witnessed by her family. She also presented earlier in the evening of the previous evening because she continued to have seizures. She is a history of CVA, hypertension, bipolar disorder. The patient has required intubation in the past. Her laboratory work is essentially unremarkable, phosphatase of 26, AST of 72 and ALT of 75. Dilantin levels are not reported at this point. The case was discussed with Dr. Amr Kahf. I

Many studies have suggested that managing nonconvulsive status epilepticus (NCSE) presents many challenges, which would benefit from additional early measures to predict patient outcomes. Non-convulsive status epilepticus (NCSE) is status epilepticus without obvious tonic–clonic activity. NCSE is now known to be a heterogeneous disease with a variety of reasons, several subtypes (Shenker and Foundation 2003). In the mental status testing study researcher stated most patient were unexplained reduced level of consciousness or altered mental status and they only administer Folstein Mini-Mental State Examination (MMSE) when patients very mildly impaired. To determine the usefulness of the NCSE divided into Standardize NCSE exam and Glasgow coma

Epilepsy and Seizure Disorder: All actions and functions travel to the different parts of the brain much like electrical wiring. The “electricity” moves from one area or wired circuit through another by jumping and traveling from area to area much like electricity Due to abnormal electricity and “jumping” seizures can occur. Epilepsy is where these electoral abnormalities are reoccurring often causing many seizures. The Tonic-Clonic or Grand Mal seizures that CM has is from muscles tightening and relaxing very fast due to the abnormal jumping of electricity in the brain. P. 417

Choosing an appropriate antiepileptic drug is the key to successful medical management of epilepsy in children. The choice of antiepileptic drug depends on several factors, of which the most important is accurate seizure classification. The other factors used to choose an appropriate antiepileptic drug include the side effect profile of the drug, The available age- and patient-appropriate preparations of the drug, Whether therapeutic levels are needed quickly or not (depending on the frequency and severity of the patient’s seizures), and the patient’s comorbidities.

ellipse area measured from the SODP of IMFs has been used as a feature in order to discriminate

The study by Amato, Minozzi and Davoli (2011) examined five randomized controlled trials to find an efficient and safe medication to treat AWS. The study which had a total of 7333 patients concluded that benzodiazepines were better for controlling seizures when compared to a placebo and antipsychotics (Amato et al., 2011). When comparing benzodiazepines versus anticonvulsants, researchers concluded that the benzodiazepine chlordiazepoxide had better outcomes. No other studies were found which would compare the effectiveness among benzodiazepines for the treatment of AWS.

Partial seizures also referred to as focal seizures, have abnormal excited neuron activity on one part of the brain and in some cases it can increase to other parts of the brain. These specific areas are called the seizure focus. As the activity typically stays around where it started from, there is the potential for it to spread due to the failure of inhibitory mechanisms. Within the seizure focus, neurons experience depolarization, which is then followed by a line of action potentials. The activity involved is defined as proximal depolarizing

With the increase of antidepressants being prescribed in the UK, in 2012, it reached over a half a million prescriptions. Some indications have shown with the increase of antidepressants is a rise in epilepsy/seizures, only a small number of researches have been done on people for “long-term” use. In the UK 1 in 100 people are diagnosed with epilepsy, the disorder is severe

Epilepsy Research Paper People most often associate violent twitching, falling to the floor and drooling with epilepsy. However the described event is only one kind of an epileptic seizure, which is called a tonic-clonic seizure. There are many other kinds of seizures, and each has different sets of signs and symptoms. During generalized seizures the whole brain is affected and the initial symptom is loss of consciousness. This category includes such seizures as absence seizure, myoclonic seizure, and atonic attack.

Treatment for epilepsy is often focused on controlling the seizures with the least amount of medication as possible. Antiepileptic drugs (AEDs) are the class used to accomplish this. Some of the AEDs that are used most often are Clonazepam, Diazepam, Divalproex, Gabapentin, and Phenytoin. The most common side effects of these medications include nausea, vomiting, sedation, fatigue, and lethargy. (Kwan,1; Benbadis, 3-5; Huethers,637)