Management of uncontrolled convulsions in status epileptics

Management of uncontrolled convulsions in status epileptics (neurofibromatosis syndrome)Introduction : Convulsive status epileptics cases are considered an emergency in children especially if convulsions are long lasting without any recovery time between seizures which need immediate management to airway . breathing and circulation to preserve lfe first and then act to control the convulsions which is life threating if prolonged because it may lead to respiratory arrest .Aim of work : To find a way which can manage the uncontrolled convulsions in status epileptics case .Methods : I searched the medical sites as pubmed database .cocharne . medscape and others for clinical trials . meta analysis . randomized control studies and researches talking about status epileptics and management should be taken to control the convulsions .Results : Researchers recommend that after establishment of the patient ABC . we should try to find venous access to give anticonvulent medications .If there is a venous access we start to infuse 0.1 mg/kg lorazepam as an effective anti convulent ( over 30 : 60 sec ) and then wait .if there is no response within 10 minutes give another dose of lorazepam which is more effective than diazepam and also less respiratory depression . if there is no response within 10 minutes we should turn to phenytoin 18 mg/kg IV and paraldehyd 0.04 ml/kg and wait .If convulsions persist more than 20 minutes we should use general anesthesia and put the patient on mechanical ventilation in an intensive care unit .Conclusion : Lorazepam is the best choice anticonvulent and better used in convulsive status epileptics than rectal diazepam if there is a venous access because it has less or even no depressive action on respiration .If there is no responce or recovery after infusion of different anticonvulsent medications we should save the patient life by using a mechanical ventilator and start other interventions.References :1. Appleton R, Macleod S, Martland T. Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children. Cochrane database Syst Rev [Internet]. 2008 Jan [cited 2014 Apr 19];(3):CD001905. Available from: http://www.ncbi.nlm.nih.gov/pubmed/186460812. Capovilla G, Beccaria F, Beghi E, Minicucci F, Sartori S, Vecchi M. Treatment of convulsive status epilepticus in childhood: recommendations of the Italian League Against Epilepsy. Epilepsia [Internet]. 2013 Oct [cited 2014 Mar 23];54 Suppl 7:23’34. Available from: http://www.ncbi.nlm.nih.gov/pubmed/240990533. Chin RFM, Neville BGR, Peckham C, Wade A, Bedford H, Scott RC. Treatment of community-onset, childhood convulsive status epilepticus: a prospective, population-based study. Lancet Neurol [Internet]. 2008 Aug [cited 2014 Mar 21];7(8):696’703. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2467454&tool=pmcentrez&rendertype=abstract4. Lee J, Huh L, Korn P. Guideline for the management of convulsive status epilepticus in infants and children. 2011;(August):279’85.5. Riviello JJ, Ashwal S, Hirtz D, Glauser T, Ballaban-Gil K, Kelley K, et al. Practice parameter: diagnostic assessment of the child with status epilepticus (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology [Internet]. 2006 Nov 14 [cited 2014 Apr 17];67(9):1542’50. Available from: http://www.ncbi.nlm.nih.gov/pubmed/171018846. Shorvon S, Ferlisi M. The treatment of super-refractory status epilepticus: a critical review of available therapies and a clinical treatment protocol. Brain [Internet]. 2011 Oct [cited 2014 Mar 23];134(Pt 10):2802’18. Available from: http://www.ncbi.nlm.nih.gov/pubmed/219147167. The S, Party MO, Appleton R, Choonara I, Martland T, Phillips B, et al. The treatment of convulsive status epilepticus in children. Arch Dis Child. BMJ Group; 2000;83(5):415’9.8. Treatment of convulsive status epilepticus. Recommendations of the Epilepsy Foundation of America’s Working Group on Status Epilepticus. JAMA [Internet]. 1993 Aug 18 [cited 2014 Apr 19];270(7):854’9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/83409869. The treatment of convulsive status epilepticus in children. Arch Dis Child [Internet]. 2000 Nov 1 [cited 2014 Apr 19];83(5):415’9. Available from: http://adc.bmj.com/cgi/doi/10.1136/adc.83.5.415

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