Status of Epilepticus, Severity in People with Epilepsy

If you often experience seizures or suffer from epilepsy, you must be careful. Because, in this disease there are seizures known in medical language as status epilepticus. Status epilepticus is epileptic seizures lasting more than 30 minutes. This condition is a critical emergency situation and requires immediate treatment. Epilepsy is a condition that affects the brain and causes seizures to occur repeatedly. Seizures themselves are sudden electrical spikes in the brain. Status epilepticus is a form of fatal epileptic seizures that is quite common. This condition can appear as an acute form of an epileptic seizure that has previously been suffered, the first form of an epileptic seizure, or arise due to other abnormalities that could potentially cause severe seizures. This condition can occur at any age, but tends to be more prevalent in the elderly with concomitant diseases. Risk factors that can cause this condition include old age, genetic congenital or family history of epilepticus status, growth retardation, and brain disorders.

Causes Epileptic status and treatment

When you have epilepsy, you tend to experience seizures. In the condition of the seizure, there is a condition called epilepticus status. Status epilepticus is a life-threatening neurological disorder that is basically an acute and prolonged attack of epilepsy. Status epilepticus is defined as a continuous seizure that lasts more than 30 minutes continuously, or the occurrence of seizures twice or more without full recovery of consciousness. Seizures lasting more than 5 minutes also need to be considered as status epilepticus. In people with a history of epilepsy, this condition is often caused by changes in antiepileptic drugs, following the dosage or type of drug used. In addition, other conditions that can cause this serious condition include stroke, hypoxia, severe head injury, brain tumor, cancer, electrolyte abnormalities, brain infections, poisons or drugs such as cocaine, theophylline, and symptoms of alcohol withdrawal. Symptoms of epilepticus are difficult to categorize because there are various types of seizures. Symptoms that appear in every patient with epilepsy are also different. However, by monitoring the brain's electrical waves with EEG, in general the symptoms that can appear in the status epilepticus are divided into two, namely the type of convulsive and non-convulsive. The symptoms caused by the status of non-convulsive or sensory type epilepticus include paresthesia or sensory abnormalities on one side of the body, changes in vision, experiencing blurred vision or the presence of color hallucinations, the presence of hallucinations in the sense of taste and smell, the presence of uncomfortable sensations which cannot be explained in the abdomen. Convulsive or motor type epilepticus status can cause symptoms such as decreased consciousness, stiff muscles throughout or part of the body, muscle spasms in parts or all of the body, stiff jaws, bites on the cheeks or tongue, sudden stopping breathing, and bluish skin. Before the seizure appears, sufferers of epilepsy can experience sensory symptoms such as the status of non-convulsive type epilepticus. This condition is called aura. It is important to know the type of seizure because each type of seizure can describe the cause and location of the disorder in the brain.

Management of seizures due to epileptic status

When looking at someone who has a seizure or status epilepticus, there are a number of important things to do, including:

• Secure the airway and pay attention to breathing and heart function. If there is a decrease in consciousness and the patient has difficulty breathing, intubation will be needed, which is installing a breathing apparatus to support respiratory function and optimal oxygen administration. This intubation must be carried out by medical personnel or people who have received special training.
• Ensuring the head is protected, undressing on the neck like a tie that can interfere with breathing, and keep away from dangerous positions.
• Remove sharp objects such as glasses from around a seizure to prevent injury.
• Do not hold a person who is having a seizure or put any object in the mouth of the person who is having a seizure, because this can result in injury.
• Call an ambulance if the seizure has been going on for more than 5 minutes after an emergency anticonvulsant drug is given, the person has a history of frequent seizures or has epilepticus status, as well as a concern or difficulty in monitoring the airway (breathing, circulation, or other vital signs).
• If the seizure has passed, do not let the person experiencing the seizure himself, because he will feel confused.
• In addition, avoid the potential danger of a high place or moving machine at home, school or workplace if you have active seizures. Even if your seizure is under control, you still have to anticipate the specific risks of certain activities such as cutting, driving, using heat equipment, and so on.

Because seizures and epilepticus status can be caused by various things, it is important to check this emergency condition to the doctor as soon as possible to get a complete examination. When in hospital, the doctor will do a physical examination and evaluate the type of seizure if the symptoms of seizures appear while in hospital. In addition, the doctor will also conduct supporting examinations, such as complete blood tests, electrolytes, blood gas analysis, blood sugar, kidney and liver function, toxicology and levels of anti-seizure drugs in the blood (if possible), EEG, and CT scan, or MRI of the head . If a brain infection is suspected, it may be necessary to examine the brain fluid through a lumbar puncture. Patients with epileptic status need close monitoring and evaluation in the hospital. After the cause of seizures or epilepsy is known, the treatment is adjusted to the cause. People who suffer from epilepsy are usually treated with anti-epilepsy drugs, and about 70% of people with the condition are able to control their seizures with this drug. Some types of drugs to treat epilepsy include carbamazepine, diazepam, lorazepam, midazolam, phenytoin, and others. To treat seizures before being taken to hospital, diazepam can be given through the anus for children. In the ED, initial treatment of epilepticus status with a venous injection of benzodiazepine drugs such as midazolam, diazepam, or lorazepam can be given. After initial treatment but seizures continue, or the seizures enter the 20th minute, they can proceed to the second phase with anti-epileptic drugs such as phosphphenytoin, valproic acid, or levetiracetam injections. If these three types of drugs are not available, phenobarbital can be used. If after the second phase there are still seizures or seizures that have lasted more than 40 minutes, then it can be repeated administration of the second phase of drugs or administration of general anesthesia such as propofol, thiopental, or midazolam. After that, patients with epilepticus status need to be monitored in a hospital and treated in an intensive care unit (ICU). Anti-epileptic drugs can not cure this disease, but can prevent seizures from happening. The type of anti-epileptic drug recommended for you will depend on a number of factors, such as the type of seizure you have, your age, whether you are planning to become pregnant, or whether there are concerns about certain anti-epileptic drugs that interact with other drugs (such as contraceptive pills ). Anti-epileptic drugs need to be taken according to the dosage stated on the label of the drug and doctor's advice. If there are side effects from these drugs, or seizures still occur even though anti-epileptic drugs have been given, you need to immediately consult a doctor or neurologist to get the right treatment. In addition, it is important for you to remain active, but it is advisable to choose sports and other activities wisely so as not to trigger injury or injury during seizures during exercise. Even if you already know information about epilepsy and epilepticus status from the above explanation, still consult your health if some of the symptoms that have been described are happening to you or the people closest to you. Status epilepticus is a dangerous condition that has high potential to cause disability and even death. Do not delay to get treatment immediately to avoid fatal complications.