Drug of choice for status epilepticus is: September 2011, March 2013
Ans. C: Lorazepam Intravenous Lorazepam is now the treatment of choice for controlling seizures in status epilepticus Status epilepticus/SE It is a life-threatening condition in which the brain is in a state of persistent seizure. Definitions vary, but traditionally it is defined as one continuous unremitting seizure lasting longer than 5 minutes, or recurrent seizures without regaining consciousness between seizures for greater than 5 minutes. It is always considered a medical emergency. There is some evidence that 5 minutes is sufficient to damage neurons and that seizures are unlikely to self-terminate by that time. The moality rate of status epilepticus has the potential to be quite high (at least 20%), especially if treatment is not initiated quickly. Only 25 percent of people who experience seizures or status epilepticus have epilepsy. Causes include: - Stroke - Hemorrhage - Insufficient dosage of a medication already prescribed to the patient. Such causes of this include: Forgetfulness on the pa of the patient in taking scheduled doses, or failure to take doses at the scheduled times Taking medicine at wrong times as a result of a time zone change while traveling Dislike of the medication or its side effects - Sudden withdrawal from a seizure medication. Such causes include: - Consumption of alcoholic beverages while on an anticonvulsant, or alcohol withdrawal. Dieting or fasting while on an anticonvulsant - Staing on a new medication that reduces the effectiveness of the anticonvulsant - Developing a resistance to an anticonvulsant already being used Gastroenteritis while on an anticonvulsant. This is because the digestive system may force out the anticonvulsant, thereby rendering the body with a lack of protection - Metabolic disturbances--such as affected kidney and liver Status epilepticus can be divided into two categories -- convulsive and nonconvulsive, the latter of which is underdiagnosed The benzodiazepine of choice is lorazepam for initial treatment due to its relatively long (2-8 hour) duration of action when injected, and its rapid onset of action, which is thought to be due to its high affinity for GABA receptors and to its low lipid solubility which causes it to remain in the vascular compament. If lorazepam is not available, or intravenous access is not possible, then diazepam should be given. Paicularly in children another, increasingly popular treatment choice is buccal and intranasal midazolam, which can be given into the side of the mouth.
Valproate
Phenytoin
Lorazepam
Carbamazepine