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Monitoring

• Perform EEG monitoring for:
  • Continued seizure activity
  • Termination of seizure activity
  • Recurrent seizure activity
  • Unexplained coma despite termination of overt seizures
• Monitor for complications of SE and complications of therapy.
  • Rhabdomyolysis, renal failure, liver failure, aspiration pneumonia
• Monitor anticonvulsant drug levels.
  

Complications

• Cardiorespiratory dysfunction
  • Hypoxia
  • Aspiration pneumonia
  • Arrhythmia
  • High-output cardiac failure
• Hyperthermia
• Metabolic derangements
  • Lactic acidosis
  • Hyponatremia
  • Hyperkalemia
  • Hypoglycemia
  • Hypercapnia
• Acute renal failure due to rhabdomyolysis
• Profound CNS injury can occur when the patient is paralyzed with neuromuscular blockade but continues to have electrographic seizures.
• Irreversible neuronal injury
• Death

Prognosis

• Prognosis is dependent on underlying disorder.
• Mortality rate is 20% in tonic-clonic status.
• Incidence of permanent neurologic sequelae is 10–30%.

Prevention

• Secondary prevention
  • Adequate therapeutic control of underlying seizure disorder
  • Compliance with anticonvulsant regimen
  • Parents of children diagnosed with epilepsy should be educated regarding the steps to take if a seizure does not rapidly terminate.
    • For children at high risk for SE (e.g. previous history of SE, younger age at onset), parents can be given abortive therapy to be used prior to arrival of emergency medical services.

The Harrison's Practice Preview allows you to view 5 FREE complete topics or conduct a search that delivers abstracts for more than 450 medical topics. For full access, please subscribe today!