Treatment Of Status Epilepticus

Status epilepticus is a continuous seizure state that can prove fatal unless the convulsions are terminated. It is a leading cause of death in epileptic patients and must be considered a medical emergency.The choice of drug may not be as important as establishing and correcting the cause of the seizures, maintaining vital functions, and beginning drug treatment as soon as possible. Virtually any general CNS depressant, including general anesthetics, can be used to terminate the seizure state. The pharmacological treatment of choice at present consists of intravenous infusion of either diazepam or lorazepam (the only benzodiazepines available in the United States for parenteral administration) or fosphenytoin.

Fosphenytoin (Cerebyx) is a prodrug that is highly soluble in intravenous solutions without solubilizing agents and is supplied in vials for intravenous use. Fosphenytoin is converted to phenytoin following par-enteral administration. It is very effective in terminating seizures and will stop most status epilepticus episodes and provide long-term control without any decreased level of consciousness. All of these drugs should be administered slowly to avoid respiratory depression and apnea.

^Study Questions

1. A 10-year-old boy with generalized tonic seizures is seen by his dentist at a routine checkup. The dentist observes that the patient has an overgrowth of gum tissue. The patient was most likely receiving which of the following agents?

(A) ethosuximide

(B) clonazepam

(C) primidone

(D) phenytoin

(E) zonisamide

2. The metabolism of which AED frequently displays zero-order kinetics following moderate to high therapeutic doses?

(A) Carbamazepine

(B) Phenytoin

(C) Valproic acid

(D) Ethosuximide

(E) Zonisamide

3. Many anticonvulsant drugs, as a major part of their mechanism of action, block the sodium channel, but other effective agents do not use this mechanism. Which of the following anticonvulsants has the ability to block T-calcium currents as its primary mechanism of action?

(A) Ethosuximide

(B) Phenytoin

(C) Topiramate

(D) Carbamazepine

(E) Lamotrigine

4. A 14-year-old patient is diagnosed with absence epilepsy. Any of the following drugs could be considered a reasonable choice to prescribe EXCEPT

(A) Ethosuximide

(B) Phenobarbital

(C) Carbamazepine

(D) Valproic acid

5. Which of the following agents has the capacity to inhibit the reuptake of GABA into neurons and glia?

(A) Zonisamide

(B) Vigabatrin

(C) Tiagabine

(D) Ethosuximide

(E) Gabapentin

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