Status Epilepticus

[s10sleeper]

I am sure that many of us here have experienced a situation of status epilepticus, I know that I have quite a few times, to the point that the doctors actually prescribe me a bottle of ativan to be administered to me sublingually if possible. This has made me wonder as I have searched many places about what meds are used for it and why.

Anyways, I have been trying to find some info in regards to these different medications as for some reason anti-epileptic drugs seem to really interest me, especially in the fact that many of them are not known why they work.

What I have really been wondering lately is if there is any kind of list of meds used for Status Epilepticus, why they are used, their effectiveness and other stats on them. I know that Benzodiazepines are usually first line treatment for them, but I wonder with these different meds, such as the different benzos and all the other types of meds, why certain ones are used more often, how they are administered, their effectiveness and how they work.

I would love to find some kind of data, especially scholarly data with graphs and numbers on it along with other details as this is one of the few things that really intrigues me and can really keep my attention for long periods of time. Otherwise I cannot focus for long periods of time on things that require alot of attention as I start to drift off very badly.

If anyone knows of any good links it would be very appreciated.

[Nakamova]

I think Lorazepam (Ativan) is the medication of choice for status because it is fast-acting, and because its anti-convulsant effect lasts 4-12 hours (compared to only 20 minutes for diazepam).

If you scroll down in this link, it talks about the meds administered for status, and why:
https://www.ebmedicine.net/topics.ph...77&seg_id=1530

[s10sleeper]

Thank you very much for that info. This is really interesting because a couple of years ago the ER put me on Tramadol for an injury. Later that evening after taking the tramadol I went into a status seizure. According to my brother who rushed me to the ER he said they first ran a tox screen and waited for the results. My brother was yelling at the nurse to give me IV Ativan as that is what I have been given when I was in a sleep deprived eeg study and went status.

After they got the results realizing that I had taken nothing other than my regular meds, they had no idea what to do and were wanting to wait it out. My brother got fed up, called my epileptologists pager and left a message that I was in the ER in Status epilepsy.

She immediately called the ER and was speaking with the Dr while my brother was around, they told her I was in earlier and that they gave me Tramadol for pain. He said he overheard her yelling at them asking why in the world they gave an epileptic Tramadol. They said they were not sure what to do, spoke very briefly and finally put ativan in my IV.

The Dr. said the reason they ran the tox screen was to rule out drug abuse. This sounds pretty sad to me considering that they were not all that concerned about me being status over 30 minutes. For that reason I refuse to go to the ER here at all. I am the same way with the First Care clinic as the Dr. tried giving me a script for tramadol and I told her she'd better look at my list of meds I cannot take. Another time she even tried to give me penicillin, which I am deathly allergic to. The First care clinic is horrible, you wait an hour past your scheduled appt time before the nurse takes you back and gets your vitals, sometimes they even forget to take some vitals like BP and never weigh me. Then you wait in the room another 30 minutes and then the Dr comes in and is out in less than 5 minutes. I have timed them with a stopwatch and it has never been over 5 minutes. They also refuse to call in prescriptions, they require you to take them to a pharmacy. Along with this, their cost for people that make over 900 a month is 150 dollars cash if you don't have full medicaid.

Funny how ER doctors and bottom of the barrel clinics work, huh? LOL

[Nakamova]

Yeah that sounds pretty terrible -- and scary. It's amazing that the quality of hospital/ER care can vary so much. To be fair, certain clinics and hospitals are often overwhelmed by patients, and minimally staffed.

It is normal to run a tox screen when someone comes in to the ER with a seizure -- but it's not normal to do so if they are already known to have epilepsy. And it's certainly not normal to withhold medication if they are in status! For my very first seizures (including one I had in the ER) they gave me valium and Dilantin.

[Jfpinell]

This sounds pretty sad to me considering that they were not all that concerned about me being status over 30 minutes. For that reason I refuse to go to the ER here at all. I am the same way with the First Care clinic as the Dr. tried giving me a script for tramadol and I told her she'd better look at my list of meds I cannot take. Another time she even tried to give me penicillin, which I am deathly allergic to.

Funny how ER doctors and bottom of the barrel clinics work, huh? LOL

There are hospitals in my area I won't go to again! I even have written on my File Of Life card where I want to go. The last time I was at one in paticular, they gave me 10 Dilantin to take (total 1000 mg) when I was hardly able to sit up yet. Uhhhh...let's see, giving oral medication to someone half into it. Not to mention I've read in drug guides that 1 gram (1000 mg, if my math is right) can be toxic! Then they let me go before I was fully aware of where I was or what was going on yet. (Needless to say I wasn't able to verbalize I don't feel right yet.) Well, I ended up walking out the wrong door, not knowing exactly where I was yet, and (managing somehow without falling) ended up walking all the way around the building trying to "find" where I wanted to (needed to?) get to.
Helloooooooo! Can you say "liability" Doc.??? What in blazes would they have done, or what would've happened to them if I would've walked out into traffic??!! (That's exactly how bad I was yet at that point....after I was able to think and reason again -about an hour+ later- I was scared to death when I realized what had happened and that I didn't wander out into the street!) You'd think that even if they were busy, they would've noticed how out of it I was and at least told me to go sit down and have the staff keep an eye on me to make sure I didn't try to go anywhere. (I've been going to that hospital ever since I was a baby, so you'd think it would say in my chart how often I've been there and my condition.)
By the way, this is a well-established hospital running for over 100 years!

[s10sleeper]

Yeah, unfortunately the ER in this city and what they call the First Care Clinic, which is the only place that accepts patients without full insurance, as all I have is the medically needy plan, are horrible. I have talked to others that go there but have full BC/BS health insurance and they get treated great.

I think they seem to have things against people that are on disability and state assistance, especially when they normally look healthy as I don't show any physical problems other than my scars on my head from surgery.

Oh, yeah, another funny one, when i went to the first care clinic, not only did they try to prescribe tramadol, but they wanted me to have my back MRI'd. That one was real funny because it says in my folder do not give me an mri due to my RNS implant. It also says it on my ID card and also on my medical bracelet. I told her I would not do it and she asked me why. Needless to say, currently I have no regular doctor, just my epileptologist and the mental health center. I finally got on the states Working Disabled plan which I have to pay a monthly cost for, but then there is no spend down, so I have more doctors available to me.

[Endless]

Sleeper & Everyone else,

I'm so sorry you got such terrible care from the emergency room. Care really IS variable, depending on both the hospital and the skill of the ER doc that you get. I've been treated by the ER in my local hospital and I won't go back. I was misdiagnosed. I went home and laid low and my regular doctor called me the next day saying she'd gotten the test results, called me into her office, and took care of it there.

I've asked my family that if I have a choice, I want to be driven into the city to one of the better hospitals. I got fabulous care in the ER there. I was treated by a doctor that looked like he was about 12 years old, but I got fabulous care.

Sleeper, you asked for articles with pictures or graphs. Here are a couple more links with flowcharts and graphs.

http://www.gosh.nhs.uk/clinical_info...uideline_00038

http://faculty.neuroscience.ucla.edu...tion_id=224363 (look on page 7)

[s10sleeper]

Thank you so much, Endless, that first one was exactly what I needed, easy to understand and look over. It seems to me that according to this the ER here in this town has no clue what they are doing. LOL

Oh well, at least I survived, although I never realized it was considered status after 5 minutes as I have had many in the past that lasted over that. I did know however that a seizure longer than 5 minutes may cause some damage, especially with mesial temporal sclerosis as I have found out, I don't recall where, that this could be the reason my seizures came back worse and continued to get even worse as they progressed these past few years. I am really starting to thing that the Neuropace RNS is helping alot though as my seizures have seemed to become completely nocturnal these days except for some auras, though when they do happen I still don't go into a complex partial until I start to fall asleep.

Anyways thanks again for the info. Graphs and spreadsheets are the easiest for me to comprehend and I love learning more info about epilepsy.