Epileptic status

Description:

The epileptic status (эпистатус) is a state at which epileptic seizures follow one by one (usually more than 30 minutes), and in intervals between attacks of the patient does not recover consciousness. The status can arise as a complication of epilepsy or to be its manifest manifestation. And the following paroxysm comes when yet disturbances in an organism including in TsNS (Central nervous system) caused by the previous attack were not liquidated. At the same time disturbances of work of bodies and systems progressively collect. If in pauses between attacks (or their series) the condition of the patient relatively is normalized, consciousness is to some extent recovered, and progressive disturbance of work of bodies and systems is not observed, then this state is called by "serial epileptic seizures", and it qualitatively differs from an epistatus. The pathophysiological basis of all kinds of an epistatus in principle is identical, distinction consists only in completeness of involvement of a brain in an epiaktivnost. The epistatusa is the cornerstone continuous (or discontinuous, but often repeating) paroxysmal collective electric activity of neurons of a brain. Further emergence of pathological excitement on neural circles as it happens in a myocardium at its fibrillation that leads to support of the status of epipripadok by the principle of a vicious circle takes place. Depending on extent of involvement of different departments of a brain in this activity (in other words, depending on extent of generalization of attacks), character of an epistatus can be various. Radical difference of the epileptic status from a single epiletichesky attack is inability of an organism to its stopping. During the status not necessarily deep (to a coma) consciousness disturbance. In some cases formal consciousness can even be kept.

Symptoms of the Epileptic status:

The epileptic status of "grand mal" (the developed convulsive attacks).
These are regularly repeating attacks with tonic and clonic phases and full switching off of consciousness or not completely generalized convulsive attacks. But there can be also regularly repeating attacks with atypical muscular activity (for example, the isolated reductions of separate muscular groups, only tonic spasms or only clonic spasms) and full switching off of consciousness. The pathological situation threatens life when toniko-clonic spasms cause a hyperthermia and acidosis (because of long muscular activity) or, more rare when the hypoxia and injury of a brain arise owing to respiratory or cardiovascular insufficiency. In this case it is about ongoing activity of the convulsive center against the background of high convulsive readiness of a brain. "Generalized", "convulsive" forms of the status indicate only involvement in an epiaktivnost of bark of the premotorny zones of a brain which are responsible for the movements of muscles. Manifestations of paroxysmal activity of other zones of a brain are simply not visible to us without EEG.

Epileptic status of absentias epileptica of "petit mal" (small attacks).
The status of absentias epileptica (regularly repeating attacks without muscular activity, but with full switching off of consciousness) can last for hours imperceptibly for people around (patients have some confusion of consciousness, a carelessness, is more rare — a coma, but without spasms. In this case an impression is made that the patient has a twilight condition of consciousness. In this case it is about high convulsive readiness of a brain in the absence of the convulsive center. On EEG the continuous complexes characteristic of a small attack, or a combination of multiple complexes peak wave are registered.

Difficult partial "epileptic status".
The status of partial epileptic seizures (usually motive, is more rare — sensitive) still it is accepted to call epilepsia partialis continua. The difficult partial epileptic status (the status "focal" or "jacksonian" (that is somatomotor) attacks) with the isolated ongoing spasms in a certain group of muscles (a face, one extremity, gemi-type spasms), proceeds without consciousness switching off. In this case it is about ongoing high activity of the convulsive center against the background of total absence of convulsive readiness of a brain. It does unauthorized inclusion of this state in the concept "Epileptic Status" as unconsciousness in an interval between attacks is a key component directed by this diagnosis. But, nevertheless, usually this state is considered together with the epileptic status or even in its framework as in this case there is not stopping activity of the convulsive center, though against the background of total absence of convulsive readiness of a brain.

Reasons of the Epileptic status:

The reasons which can cause эпистатус:

  1. Epilepsy (as a rule, to an epistatus conducts disturbance of a regularity of reception of anti-epileptic drugs)
  2. Craniocereberal injury (frequent reason)
  3. A tumor or other volume formation of a brain (the most frequent reason after actually epilepsy)
  4. Inflammatory diseases of a brain and its covers
  5. Acute disorder of cerebral circulation (frequent reason)
  6. Cicatricial and commissural disturbances of a cerebral likvorodinamika
  7. Dismetabolichesky states (alcoholic abstinence, diabetes, porphyria, acute adrenal or thyroid insufficiency, uraemia, eclampsia, acute hypoglycemia, etc.)
  8. Poisonings
  9. Systemic infections, especially with heavy intoxication and a hyperthermia

The epileptic status meets frequency of 18-20 cases at 100 000 population and is one of the most widespread neurologic states. The most often epileptic status arises at babies, children of younger age and elderly. About 5% of the adult patients who are under observation of epileptic clinics had at least one episode of the status in the history of the disease, children have this figure — about 10-25%. Most frequent "suppliers" of the statuses — lobnodolevy epilepsies.

Treatment of the Epileptic status:

The help at the epileptic status consists in carrying out a complex of urgent medical actions. At the same time it is necessary to work quickly and vigorously. The volume of first-aid treatment depends on where there was an epileptic status: on the street, in medical institution, on production, transport etc. If the status developed at home, it is necessary to call the ambulance car urgently. Before arrival of an ambulance crew of the patient it is necessary to turn sideways that there was no aspiration of lungs slime and emetic masses, and also to prevent retraction of language. To remove slime from an oral cavity and to take out prostheses of teeth.

First aid whenever possible pursues the aims: a) stopping of spasms; b) ensuring passability of respiratory tracts, the prevention of development of asphyxia owing to aspiration of slime and emetic masses or retraction of language; c) maintenance of cordial activity; d) fight against wet brain.

In some large cities specialized neurologic ambulance crews which leave to urgentny neurologic patients, including to patients with the epileptic status are created.

Anticonvulsant actions begin with diazepam use (Seduxenum, Valium). Intravenously enter (20 mg) 2 ampoules — 4 ml of 0,5% of solution of Seduxenum together with 16 ml of 40% of solution of glucose (to enter slowly!). If intravenous injection is complicated, then Seduxenum is entered intramusculary. Intramusculary also the injection of lytic mix becomes: Promedolum — 1 ml of 2% of solution, analginum — 2 ml of 25% or 50% of solution, Dimedrol — 2 ml of 1% of solution, novocaine — 2 ml of 0,5% of solution.

As dehydrational means use furosemide (lasixum) of 1 — 2 ml of 2% of solution intramusculary. From cardiacs intravenously (slowly!) enter Korglykonum of 1 ml of 0,06% of solution or digoxin of 0,5 — 1 ml of 0,025% of solution.