Question

Discuss the medical management of status epilepticus.

• Why is it considered a medical emergency?
• What education could be given to patients with epilepsy?

Describe the pharmacologic treatment of increased intracranial pressure (ICP).

• What is the use and purposes for mannitol (Osmitrol) in the treatment of increased ICP?

A patient has visual and auditory agnosia.

• Which of the cerebral areas are affected?
• What cerebral area would be affected by tactile agnosia?
• What cerebral area would be affected by body parts and relationships with agnosia?

Answer 1

1. Medical management of Status Epilepticus

Epilepsy: A medical condition in which sufferer experiences seizures ( convulsions)

Status Epilepticus is chcharacterized by prolonged seizure episode ( more than 5minutes) or more than two seizures within 5 to 10 minutes , before the person's recovery from the first episode.  It is a medical emergency, some time it is life threatening.

Medical management

* Benzodiazepines: These drugs are effective for Status Epilepticus.  

Example: Diazepam( intravenous, rectal gel) Midazolam, lorazepam ( Intravenous or intranasal also available.

* Anticonvulsant drugs: Phenobarbital and Phenytoin are effective drugs ( anticonvulsants) for Status Epilepticus.

* Pentobarbital and Thiopental also can be used in case of status Epilepticus.

Other than pharmacological management, maintaining patent airway and maintaining vital signs are important measures.

2. Why Status Epilepticus is a medical emergency?

Status Epilepticus is a life threatening neurological condition as the continuous seizures may cause direct damage to the brain from the injury that led to seizure. Also continous electrical discharges may injure brain cell. Seizures may cause physical injury, falls, airway obstruction due to accumulation of secretion and continuous seizure activities may cause permanent brain damage or death due to related complications.

3.Education to patients

* Avoid activities at height, climbing,skating, biking

* Maintain normal sleeping pattern

* Avoid alcohol

* Avoid swimming

* Take all the medications as per Doctor's order at the same time

* Drink adequate water and have a healthy dietary pattern

* Avoid stress. Try for relaxation technique such as meditation.

4. Increased Intracranial Pressure ( ICP)

Normal ICP is 7- 15mm Hg. Increased Cerebrospinal fluid may cause Increased ICP.

Pharmacological management

* Mannitol

* lorazepam ( sedative and muscle relaxant)

*morphine ( pain)

5. Use and purpose of Mannitol ( Osmitrol)

Mannitol is used to reduce ICP and it is a hyperosmolar agent.  

Mannitol works in two patterns: Osmotic effects and rheologic effects( rheology means flow of a liquid) are the two effects of Mannitol . It reduces blood viscosity and Cerbral parenchymal cell water. Also causes cerebral vasoconstriction, resulting in maintenance of Cerbral blood flow ( CBF) but decrease in ICP.