INTRODUCTION:-
Status epilepticus (SE) is an important life threatening neurological disorder or emergency which causes high morbidity and mortality in patients. It requires immediate treatment to prevent permanent irreversible brain damage. Basically in this condition episodic epileptic seizures come that last more than 30 minutes without recovery of full consciousness in between the seizures. It is not necessary that every epileptic patient has this type of status epileptic condition. It is more common in young children and elderly adults.
SIGNS AND SYMPTOMS:-
The possible signs and symptoms of status epilepticus are:-
Muscle spasmFalling
Confusion
Unusual noises
Loss of bowel or bladder control
Irregular breathing
Trouble speaking
Alcohol withdrawal
Hypoglycemia
Low anti-epileptic drug levels
PATHOGENESIS:-
The
status epileptic seizures are sustained when inhibitory neurons activity is
reduced and excitatory neurons activity is high. This condition can be possible
when stroke, hemorrhage or different etiologies of status epilepticus destroy
the neuronal cells or GABA neurotransmitters are not producing by the neurons
or GABA receptors are desensitized towards the neurotransmitters.
Inhibitory and excitatory neurons always balance to each other’s activity. So when Gamma-aminobutyric acid (GABA), which is an inhibitory neurotransmitter fails to inhibit the activity of brain so for compensation glutamine, which is an excitatory neurotransmitter abnormally releases when it binds to NMDA (N-methyl-D-aspartate) receptor, the calcium influx inside the neuronal cell occurs as a result the process of excitation in brain starts. Due to which the action potential of brain disturbs and status epileptic seizures come.
INTERPRETATION:-
In status epilepticus the normal brain waves like alpha, beta, theta and delta are abnormally changed during seizure, all signal waves are generated spontaneously and produce abnormal impulses. These waves are non-rhythmic, non-systemic means all waves move in random and an improper fashion and these waves are haphazard also means they move in zigzag manner.
DIAGNOSTIC TESTS AND ITS INTERPRETATION:-
Status epilepticus diagnosis can be done by different techniques in which electroencephalogram (EEG), computed tomography (CT) scan, magnetic resonance imaging (MRI) and lumbar puncture are included:-
ELECTROENCEPHALOGRAM (EEG):-Status epileptic seizures and its symptoms of different conditions are similar like alcohol withdrawal and stroke etc. So in order to distinguish between the seizures EEG technique is used which give us pattern according to condition.
COMPUTERIZED TOMOGRAPHY SCAN (CT SCAN):- CT scan is that technique in which X-rays are used to determine the abnormilities or lesions in brain like tumor and hemorrhage etc by taking the cross-sectional images of brain, which causes the seizures.
4. LUMBAR PUNCTURE:-Lumbar puncture technique is used to diagnose the infection, by taking the fluid that surrounds the spinal cord and brain and test it to find the infection.
TREATMENT FOR MANAGEMENT OF STATUS EPILEPTICUS:-
To manage the
seizures of status epilepticus, several medications are given to the patient to
prevent the development of irreversible brain damage. The drugs must be
administered intravenously (IV) for rapid action.
1.
BENZODIAZEPINES:-Some
of the drugs of this class are used to treat acute seizures and status
epilepticus. These are diazepam, lorazepam and midazolam. These drugs are used
to increase the inhibitory effect of GABA by binding to its receptor which is
present at the interface of alpha and gamma subunits.
·
DIAZEPAM:-
o
Its brand name is Valium.
o
It is used as first-line
management of status epilepticus.
o
It is highly
lipid-soluble drug so phenomenon of redistribution occur due to which it has
shorter duration of action.
o
It can also give
intra-muscularly and rectally.
o
It is metabolized in the liver.
o
Its dose is 5-10mg.
o
Its adverse effects are
respiratory depression, hypotension and sedation and local site irritation
etc.
·
LORAZEPAM:-
o
Its brand name is Ativan.
o
It is preferred for acute
management of status epilepticus.
o
It is less lipid-soluble
drug and it is more tightly binds with its receptor than diazepam due to which
it has longer duration of action than diazepam.
o
It is metabolized in
liver.
o
Its dose is 4mg.
o
Its adverse effects are
respiratory depression, hypotension and sedation etc
·
MIDAZOLAM:-
o
Its brand name is Versed.
o
It is also used in the
treatment of status epilepticus.
o
It is water-soluble drug,
when it binds to its receptor it enhance the activity of GABA neurotransmitter
towards its receptor by which seizure activity becomes reduce.
o
Its dose is 7.5mg.
o Its adverse effects are over-sedation, local site irritation, hypotension and respiratory suppression etc.
2.
PHENYTOIN:-
o
Its brand name is
Dilantin.
o
Phenytoin is used as second-line management of
status epilepticus for treating acute seizures.
o
It is a lipid-soluble
drug.
o
It is an anti-convulsant
drug.
o
It decreases the abnormal
electrical activity of brain.
o
It is given through IV route.
o
It is metabolized in
liver.
o
dose is 18-20mg.
o
It does not cause
sedation.
o Its adverse effects are cardiac depression, hypotension, local site irritation, dizziness etc.
3.
FOSPHENYTOIN:-
o
Its brand name is
Cerebyx.
o
Fosphenytoin is a
water-soluble pro-drug which is given intravenously and converts into phenytoin
to show its effects.
o
It is also used in the
treatment of acute seizures.
o
It works by slow down the
impulses in the brain to prevent or control the seizures.
o
It is metabolized in
liver.
o
Its dose is 15-20mg.
o
It does not cause local
site irritation.
o Its adverse effects are hypotension, dizziness and paresthesias (numbness and pricking sensation) etc.
4.
PHENOBARBITAL:-
o
Its brand name is
Solfoton.
o
Phenobarbital is used
when benzodiazepines and phenytoin are unable to control this condition.
o
It is also used to
control the seizures by depressing the CNS abnormal activity.
o
It is not commonly used
because high-dose of phenobarbital can cause severe ADR’s.
o
It is metabolized in the
liver.
o
Its dose is 15-20mg.
o Its adverse effects are respiratory suppression, myocardial suppression, sedation etc.
5.
VALPORATE:-
o
Its brand name is
Depacon.
o
It is also an
anti-convulsive drug.
o
Valporate is another drug
which is used to treat status epileptic condition.
o
It can only give to the
patient intravenously (IV).
o
Its dose is 25mg.
o Its
adverse effects are local site irritation and gastrointestinal distress etc.
PROTOCOLS FOR PREVENTION OF EPISODES OF STATUS EPILEPTICUS:-
The episodes of status epilepticus can be prevented by avoiding the several practices.
- Every night sleep well and always take sleep on time.
- Learn different relaxation techniques to reduce the stress.
- Avoid
play video games.
- Try
to avoid the TV and computer.
- Only take healthy foods.
- Don’t use drugs and alcohol.
- Avoid bright and flashing lights because they can be acted as stimuli for seizures.
- Take all medications on time as prescribed by doctor, like diazepam (Valium 2mg) or lorazepam (Ativan 2-10mg).
ROLE OF CLINICAL PHARMACISTS IN MANAGEMENT OF STATUS EPILEPTICUS:-
If
a patient has seizures even after taking the medication so it is the
responsibility of pharmacist to find out the problems:-
- Pharmacist should have to counter check if drug selection is not appropriate according to the condition which causes the seizures.
- If proper dose of drug is not given to the patient, pharmacist have give appropriate dose according to situation.
- Most important thing is the drug route which is has to be correct.
- The drug-drug interaction may not occur such as the OTC or antidepressant may not given that can produce seizures.
- Pharmacist checks the electrolytes and glucose level in the serum and also the drug level because it will give information about the desired drug concentration in the blood is present or not.
- Obtain history from patient about odor, anxiety and food etc because these things can be acted as trigger or stimuli for seizures.
ROLE OF PHARMACIST TO PREVENT THE EPISODES OF STATUS EPILEPTICUS:-
When a patient has condition of generalized seizure then pharmacist plays an important role to manage the situation:-
- Pharmacist put something in between the teeth of patient otherwise patient can bite his own tongue and can damage his teeth.
- He should place pillow or cushion under his head.
- Loose the patient cloth around his neck.
- Clear all the harmful objects away from the patient.
- He gives diazepam injection to the patient through IV route.
- After seizures the place should be ventilated to make patient relax.
- He turns the patient on one side so that patient take breathe.
- Pharmacist does not hold the patient to stop his seizures, he allows the seizure to happen because it can cause injury.
- He
deals the patient calmly and patiently.
One of the best content i have every scene thank u medicinal info center for this wounderful knowledge😊😊😊😊
ReplyDeleteYes medicinal info cebter always give right and meaningful information thnx alot😁😁💕💕
ReplyDeleteVery informative for my research and thesis😊🙏🙏
ReplyDeleteVery informative Help alot🤩🤩🤩
ReplyDeleteThank u for this💕💕
ReplyDeleteVery authentic😊😊
ReplyDelete