STATUS EPILEPTICUS: A MEDICAL EMERGENCY – THE CAUSE OF CONVULSIVE STATUS EPILEPTICUS AND ITS TREATMENT
If status epilepticus is the child’s first seizure, then the doctors will probably want to do a lumbar puncture (spinal tap) to look for infection. They will study the blood for possible chemical changes and, perhaps, do an EEG then or the next day. They may even do a CT scan.
If the child has had other seizures or has epilepsy, then looking for a cause of the status may be slightly less important.
The most common cause of status epilepticus in a person who has previously had seizures is that the level of medication in the blood is too low. This may be because the child is not taking his medication, or that it has been forgotten, or that an interaction with some other medication has lowered the level. Substitution of a generic drug that is less well absorbed may also result in status epilepticus.
In almost all instances, the status epilepticus can be controlled within one-half hour to one hour from the time the child arrives in the emergency room and treatment is started. Only in an unusual situation, when there is an acute process occurring in the brain such as infection or damage from a head injury, do seizures continue, and are they difficult to control. Treatment of severe prolonged status epilepticus can be enormously challenging for the physician, requiring large doses of medication given in an intensive care unit and sometimes requiring general anesthesia to stop the seizures.
The outcome of status epilepticus, even in these severe episodes, depends more on the cause than on the duration of the seizures. Rest assured that most children who have status recover and are just as normal as they were before the seizures. It appears to be very, very rare for children who have status without a known cause to suffer any permanent damage, even from prolonged seizures.
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LIVING WITH EPILEPSY
One wet and windy afternoon Sue Usiskin was passing her local building society when she recognized the first signs of one of her usual seizures. Wasting no time she entered, beckoning for help as she crumpled to the floor.
‘The seizure gained momentum. I felt very conspicuous as, apart from myself, the place was empty. The staff stayed exactly where they were behind the counter. None of them came to my aid as I shook and groaned.
‘Eventually the seizure subsided and I lay wondering how I might get one of the staff to ring my husband at his office nearby. As soon as I was able, I crawled across the floor to the counter, clutching my epilepsy card. I indicated my husbands work number on it and fortunately he appeared in minutes. The manager, who was still behind the counter, explained that he thought I was the diversion for a robbery and had he come to my aid there would have been a chance for an accomplice to get behind the counter.’
The problem with fits is that they are unpredictable. They can disrupt your daily routine, your education, your social life and your work. Often they provoke anxiety in others which can alter their relationship with you in subtle ways. And very occasionally, your seizures may have catastrophic consequences.
People who have epilepsy have always suffered as much from other peoples’ attitudes towards them and their condition as from the disease itself. Someone who has epilepsy may no longer be considered mad or possessed by the devil, but they are still often regarded, at the very least, as different and liable to occasional bouts of strange behaviour which may embarrass or distress the onlooker who does not understand them and does not know how to cope with them. The epilepsy sufferer may have to contend with other people’s belief that they are somehow second-class citizens, unable to live a normal life. It is often assumed that epilepsy is some form of mental handicap or that it causes a deterioration of personality, or even that it can be caught, like flu.
Sue Usiskin, herself an epilepsy counsellor whose experience is quoted above, says she always makes a point of going back to see people where she has had a seizure. If they have been helpful they usually appreciate seeing her well and having the chance to ask her questions about the condition. To those who have not been so helpful she offers some basic education about epilepsy in the form of a leaflet giving information about first aid for fits.
Shaping other people’s attitudes
The person who has epilepsy is someone who happens to have an occasional fit; between seizures he or she is as normal and capable as the person who happens to have an occasional cold. Such people do not need or want sympathy or special treatment. There are endless examples of famous people throughout history whose epilepsy clearly proved to be no barrier to the achievement of fame and even fortune. Julius Caesar, Alexander the Great and Alfred the Great were all said to have had epilepsy. The writers Jane Austen and Dostoevsky had epilepsy and so did the poet Byron. Tony Greig had epilepsy and captained the English cricket team.
In almost every case, other people’s attitudes towards your epilepsy will reflect your own. If you regard it as a minor nuisance — something you have to live with but that need not affect your capacity for life or make you different or in need of sympathy or special treatment — your friends, colleagues and the people you meet in your everyday life will adopt this view too.
However, it is sensible to warn friends and work colleagues what they should do if you have a seizure. If you have generalized tonic clonic seizures the important point to make is that, however horrifying it looks to them, it is not painful or distressing for you, because you are not in any real sense ‘there’ while it is happening.
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LIVING WITH EPILEPSYOne wet and windy afternoon Sue Usiskin was passing her local building society when she recognized the first signs of one of her usual seizures. Wasting no time she entered, beckoning for help as she crumpled to the floor.’The seizure gained momentum. I felt very conspicuous as, apart from myself, the place was empty. The staff stayed exactly where they were behind the counter. None of them came to my aid as I shook and groaned.’Eventually the seizure subsided and I lay wondering how I might get one of the staff to ring my husband at his office nearby. As soon as I was able, I crawled across the floor to the counter, clutching my epilepsy card. I indicated my husbands work number on it and fortunately he appeared in minutes. The manager, who was still behind the counter, explained that he thought I was the diversion for a robbery and had he come to my aid there would have been a chance for an accomplice to get behind the counter.’The problem with fits is that they are unpredictable. They can disrupt your daily routine, your education, your social life and your work. Often they provoke anxiety in others which can alter their relationship with you in subtle ways. And very occasionally, your seizures may have catastrophic consequences.People who have epilepsy have always suffered as much from other peoples’ attitudes towards them and their condition as from the disease itself. Someone who has epilepsy may no longer be considered mad or possessed by the devil, but they are still often regarded, at the very least, as different and liable to occasional bouts of strange behaviour which may embarrass or distress the onlooker who does not understand them and does not know how to cope with them. The epilepsy sufferer may have to contend with other people’s belief that they are somehow second-class citizens, unable to live a normal life. It is often assumed that epilepsy is some form of mental handicap or that it causes a deterioration of personality, or even that it can be caught, like flu.Sue Usiskin, herself an epilepsy counsellor whose experience is quoted above, says she always makes a point of going back to see people where she has had a seizure. If they have been helpful they usually appreciate seeing her well and having the chance to ask her questions about the condition. To those who have not been so helpful she offers some basic education about epilepsy in the form of a leaflet giving information about first aid for fits.Shaping other people’s attitudesThe person who has epilepsy is someone who happens to have an occasional fit; between seizures he or she is as normal and capable as the person who happens to have an occasional cold. Such people do not need or want sympathy or special treatment. There are endless examples of famous people throughout history whose epilepsy clearly proved to be no barrier to the achievement of fame and even fortune. Julius Caesar, Alexander the Great and Alfred the Great were all said to have had epilepsy. The writers Jane Austen and Dostoevsky had epilepsy and so did the poet Byron. Tony Greig had epilepsy and captained the English cricket team.In almost every case, other people’s attitudes towards your epilepsy will reflect your own. If you regard it as a minor nuisance — something you have to live with but that need not affect your capacity for life or make you different or in need of sympathy or special treatment — your friends, colleagues and the people you meet in your everyday life will adopt this view too.However, it is sensible to warn friends and work colleagues what they should do if you have a seizure. If you have generalized tonic clonic seizures the important point to make is that, however horrifying it looks to them, it is not painful or distressing for you, because you are not in any real sense ‘there’ while it is happening.*54\193\2*