00:01
In this lecture,
we're going to talk about
status epilepticus
or continuous seizure activity.
00:07
So really important topic
in neurology.
00:09
It's one of the medical or
neurological emergencies
that we're going to review.
00:14
Let's start with a case.
00:17
There's a 57-year-old man with a
history of focal-onset epilepsy
managed on levetiracetam
1000 milligrams twice a day,
which is a standard dose.
00:26
He's brought to the
emergency department
with convulsive seizure activity.
00:30
The patient's wife reports that
he stopped taking his medication
about four days ago,
and she found him on the ground
unconscious, and stiff with jerking
in the arms and legs bilaterally.
00:42
EMS was called
and report that the patient had two
three-minute generalized seizures
and received lorazepam
2 milligrams two times
while en route to the
emergency department.
00:54
The patient does not arouse
to verbal or tactile stimulation,
but eyes weakly open.
01:00
He's unable to follow commands.
He groans.
01:03
Neurologic examination
is nonfocal.
01:07
So what's the diagnosis?
Well, like the other patients
we've evaluated with seizures.
01:13
The first key is to look
at what happened
before the episode or pre-episode.
01:18
And here we don't know.
01:19
The patient was found
on the ground unconscious,
which is common for many
seizure evaluations.
01:25
The second step is to evaluate
what happened during the episode
during the ictal portion
of the episode.
01:31
And this patient had two
three-minute generalized seizures.
01:35
And now is unconscious,
unable to follow commands,
has not returned to baseline.
01:42
The third step is to evaluate
what happens after the episode.
01:46
And here again,
we have a patient
who is not arousing,
who has not returned
to neurologic baseline.
01:51
And that's really important
as we differentiate seizure
from possible status epilepticus.
01:57
And then there's a few
wildcard aspects here.
02:01
The stiff jerking in the
arms and legs bilaterally
indicate that this seizure
is a tonic clonic seizure,
and that will help us in classifying
this type of seizures diagnosis.
02:12
So what is the diagnosis?
Is this focal onset
convulsive seizure?
Generalized-onset
convulsive seizure?
Convulsive status epilepticus,
or a primary generalized
status epilepticus?
We don't like
the diagnosis of
primary generalized
status epilepticus.
02:30
The seizure semiology
suggests a focal onset
and not a generalized seizure.
02:37
We don't like
focal onset convulsive seizure.
02:40
The patient seizure
was focal in onset.
02:43
But he's had multiple seizures
without return to baseline.
02:47
And this indicates that
he's not suffering from seizure
and we may be dealing,
and look to be dealing
with status epilepticus.
02:54
Similarly generalized-onset
convulsive seizure
the semiology suggests
focal onset
and this patient suffering
from multiple seizures
without return to baseline.
03:03
So here the correct answer is
convulsive status epilepticus.
03:07
The patients had multiple seizures
without to return to baseline.