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.

In the present time, the usage of 24-hour EEG video monitoring have proved many past physicians incorrect about their distinction between true and false seizures. EEG/video of pseudoseizures has revealed that urination, injury, and drug responsiveness may be part of nonepileptic episodes as well as epileptic episodes. As a result, EEG/video has become the gold standard for discriminating between epileptic and nonepileptic attack (Bergen, 154-155). Both clinical observation and EEG/video have reveal that long durations of start-stop pattern, direct actions, and situational triggers are more common in pseudoseizures than in true seizures (Bergen, 154-155). In addition true tonic-clonic seizures with combination of postictal oxygen debt, accumulation of saliva, and reduce level of consciousness are often followed by deep respirations and snoring or stertorous respiratory patterns, however, pseudoseizures lack these characteristics (Bergen, 154-155). The eyes remained open in every tonic-clonic and hypermotor seizures, but were closed in almost 90 percent of pseudoseizures (Bergen, 154-155). The result have shown that it is important to be able to differentiate between pseudoseizure and true seizure, but it is also crucial that physicians be able to find the underlying cause of the seizure as well.

Epilepsy can happen to anyone of any age. The largest(47%) percent of people, developing epilepsy for the first time, being children from birth to nine years of age. The next largest age group would be ten year olds to ninteen year olds at 30%. The least amount of first time seizures comes from the forty plus age group. (According to EFA publications) Over 2.5 million people suffer from epilepsy. The international league against epilepsy describes a seizure as an alternative term for "epileptic attack". Seizures vary in there length and severity. A "tonic-clonic" seizure can last for one to seven minutes. " Absence seizures usually last for a few seconds. However, complex partial seizure" may last for thirty seconds or two

I learned that often times, ECT is used along with a general anesthesia and a brief electrical current initiated to trigger a brief seizure. Likewise, I realized that ECT is the preferred treatment when other options are not as well tolerated. After becoming more familiar with the procedure, it seems as though ECT may be a more desirable option than pharmacological interventions as drug interventions may require more time to become effective. Sometimes when a patient's signs and symptoms are overwhelming, interfering with their daily life, time is of the essence and ECT provides a quicker relief for individuals with immediate risk. After several years and improvement technology, ECT has become much safer in the past, presenting minimal possible risks - memory loss, confusion, headache or muscle ache - to the

Epilepsy is not what you think. It is a complicated disease, a disease that doesn't just affect one type of person or age. Over fifty million men, women, and children cope with this disease daily. Epilepsy is a mysterious disease to those who are unfamiliar and uneducated about the disease. Many people have preconceived notions about Epileptics. Researching the topic thoroughly, the five preconceived notions I explored have been proven to be false.

Status epilepticus (SE) is a life-threatening ailment in which the brain is in a state of persistent seizure. Definitions differ, but conventionally it is well-defined as one constant unremitting seizure lasting longer than 5 minutes, or recurring seizures without recuperating consciousness between seizures for greater than 5 minutes. When recurring seizures happen at a frequency which does not let consciousness to be recouped in the interval between seizures, it is called status epilepticus. Severe and perpetual brain impairment might arise from status epilepticus continuing for more than an hour. The lengthier the duration of status epilepticus, the more challenging it is to control and higher is the rate of morbidity and mortality. It is constantly considered a medical emergency. Etiologically, SE can be shared into 3 groups. SE can represent an exacerbation of a pre-existing seizure complaint, the early manifestation of a seizure disorder, or an insult other than a seizure disorder. In patients with known

What remains unknown is why electroconvulsive therapy is effective. A plethora of studies show the neurochemical correlates of this treatment and its relation to the anti-depressant effect, yet none are conclusive. Richard Abrams has studied ECT for years and discusses a wide variety of reasons for its effectiveness in his revised edition of Electroconvulsive Therapy. For a person who has studied this treatment for 50 years, he concludes

The ECT was being administered in theatre in the general hospital. In advance of the treatment the clients vital signs were checked and it was confirmed that consent was given. The client was then transferred to theatre. Present in the room was the anaesthesiology team, ECT nurse, surgical nurse, psychiatric consultant, registrar, psychiatric nurse and student nurse. Initially the client was hooked up to a machine to record her vital signs, anaesthetic and muscle relaxants were administered and the client was ventilated with 100% oxygen. Under anaesthetic the client has reduced capacity to breathe hence oxygen is administered, pure oxygen also reduces the deleterious effects on memory. Anaesthesia and muscle relaxants reduce the seizure threshold and the risk of injuries from motor activity during the seizure (Fink 2009). The client remained in the supine position, conductive jelly was applied bilaterally to the temples and the psychiatrist administered the electrical stimulus. The choice between unilateral and bilateral electrode placement remains

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.

Seizure disorders, according to the Mayo Clinic (2015), affect approximately 1 in 26 people in the United States. Persistent, or chronic, seizures result from a condition called epilepsy, a neurological disorder of the central nervous system. It can affect anyone regardless of age, but is more common during early childhood and after age 60. Given the number of people that seizure disorders, such as epilepsy, affect, it becomes helpful to gain a foundational understanding of the disease, including some of the causes, symptoms, and treatments available.

Rascati KL; Richards KM; Johnsrud MT; Mann TA. (2009). Effects of antiepileptic drug substitutions on epileptic events requiring acute care. pharmacotherapy.

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

seizure through controlled electric shock, under anesthesia. The process itself is under scrutiny because it is not entirely understood, which is main a reason why it is only considered in the direst of cases. ECT tends to have severe physical health risks and with the introduction of newer and less harmful antidepressant drugs, it is being used far less often (Comer, 2005). This new class of drugs includes three main types; monoamine oxidase (MAOI) inhibitors, tricyclics and selective serotonin reuptake inhibitors (SSRIs).

Epilepsy is a condition in which a person has two or more seizures affecting a variety of mental and physical functions. Epilepsy is one of the oldest conditions of the human race. Epilepsy Awareness is important because Epilepsy is a widely misunderstood disorder. The reason that Epilepsy has been misunderstood has been mainly due to research not being conducted until the middle of the nineteenth century. There are six main types of seizures and many treatments that can assist an epileptic patient. Many facts and myths exist about a person who has Epilepsy, which, is why it is an important disorder to understand. A person living with Epilepsy can typically have a normal life after seeking medical advice from doctors.

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)