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  • Image not available. Status epilepticus (SE) is a neurologic emergency that is associated with significant morbidity and mortality.
  • Image not available.Generalized convulsive status epilepticus (GCSE) is defined as any recurrent or continuous seizure activity lasting longer than 30 minutes in which the patient does not regain baseline mental status. Any seizure that does not stop within 5 minutes should be treated as impending SE.
  • Image not available. There are two types of status epilepticus, GCSE and nonconvulsive status epilepticus (NCSE). GCSE is the most common type.
  • Image not available. Most GCSE develops in patients with no history of epilepsy; however, a patient with preexisting epilepsy may experience GCSE as a result of acute anticonvulsant withdrawal, metabolic disorder, concurrent illness, or progression of neurologic disease.
  • Image not available. Although the pathophysiology of GCSE is unknown, experimental models have shown that there is a dramatic decrease in γ-aminobutyric acid—mediated inhibitory synaptic transmission and that glutamatergic excitatory synaptic transmission sustains the seizures.
  • Image not available. General treatment includes patient stabilization, adequate oxygenation, preservation of cardiorespiratory function, management of systemic complications, and aggressive assessment of underlying causes.
  • Image not available. The main purpose of treatment is to prevent or decrease morbidity and mortality of prolonged seizures. Pharmacologic treatment needs to be rapid and aimed at terminating both electrical and clinical seizures. The probability of poorer outcomes increases with increased length of electrographic seizure activity.
  • Image not available.Lorazepam is the preferred benzodiazepine in treatment of GCSE because of its long duration of action in the CNS.
  • Image not available. Currently, the hydantoins (phenytoin and fosphenytoin) are the long-acting anticonvulsants used most frequently. Either phenytoin or fosphenytoin should be given concurrently with benzodiazepines.
  • Image not available. The maximum rate of infusion for phenytoin and fosphenytoin in adults is 50 mg/min and 150 mg PE/min, respectively.
  • Image not available. If GCSE is not controlled by two first-line agents (benzodiazepine plus hydantoin or phenobarbital), the GCSE is considered to be refractory. In these cases, newer anticonvulsants and/or pharmacologically induced coma should be used.

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Upon completion of the chapter, the reader will be able to:

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  • 1. Identify patients in generalized convulsive status epilepticus (GCSE) or nonconvulsive status epilepticus (NCSE) based upon a patient’s medical history.
  • 2. Recommend common medical tests used in the evaluation and diagnosis of status epilepticus (SE).
  • 3. Contrast the classic ILAE definition of SE and the currently recognized time in which aggressive treatment is recommended.
  • 4. Describe the etiologies and risk factors for GCSE and how they are associated with patient prognosis.
  • 5. Understand the pathophysiology of GCSE and how it relates to responsiveness to treatment and patient outcome.
  • 6. Recommend nonpharmacologic and pharmacologic treatment for a patient with SE.
  • 7. Contrast diazepam, midazolam, and lorazepam based on their pharmacodynamic properties (e.g., onset, duration of action).
  • 8. Be able to discuss the differences (pharmacokinetics, dose, rate of administration, pharmacoeconomics, and adverse-effect profile) in phenytoin and fosphenytoin.
  • 9. Contrast the major classes of medications used for SE with respect to ease of use, side effects, and monitoring parameters.
  • 10. Design a treatment algorithm and monitoring plan (efficacy and safety) for ...

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