Seizure is a common presenting complaint in the Emergency Department. According to one study seizure related presentations amount to about 1% of all ED visits.
Status Epilepticus is now defined as:
5 minutes or more of (i) continuous clinical and/or electrographic seizure activity or (ii) recurrent seizure activity without recovery (returning to baseline) between seizures.” (Brophy, et al., 2012)
a) By 5 minutes a seizure is like the Energizer Bunny: it keeps going and going… and is unlikely to stop.b) The brain is frying: 30 minutes (the old definition) was too long because neuronal injury/pharmacoresistance likely occurs WAYYYY before 30 min of continuous seizing.
While there is still SOME controversy on this topic, most people have bought in. Especially Emergency Physicians. Have you ever tried to keep an ER Doc from a seizing patient for more than 30 seconds, let alone 5 minutes??
The Mnemonic: STATUS EPILEPsy
During the Year-That-Shall-Not-Be-Named (my exam year), I tried really hard to create mnemonics that actually RELATED to the topic. This helps with building neuronal connections
MedEd NERD Moment #1: Constructivist and Connectivism theories suggest that new information based on or connected to prior knowledge is more easily learned.
MedEd NERD Moment #2: For more insight into retrieval practice, check out Javier Benitez’s post to the ALiEM website!
S alicylates / Seizure med noncompliance
T ricyclic Antidepressants
A VM / Acute hydrocephalus / Anticholinergics
T rauma / Traumatic bleed (ICH, SDH)
U remia (Renal Failure)
E lectrolytes (Hyponatremia, Hypocalcemia)
I ctogenic foci (e.g. post TBI, post stroke)
L ithium / Lidocaine intoxication / Low BG
E clampsia / EtOH withdrawal
Psy-chogenic Non-Epileptic Seizures (formerly known as ‘pseudo seizures’)
This post was written by Teresa Chan and reviewed by Brent Thoma