BMJ Best Practice Podcast Status epilepticus
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Jul 14, 2022 Explore the complexities of status epilepticus, from diagnosis challenges to management strategies. Learn about distinguishing convulsive from non-convulsive status epilepticus, the use of antidepressants in epilepsy patients, and the critical need for timely intervention to prevent adverse outcomes.
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Rely On Clinical Assessment; Use EEG Later
- There are no definitive bedside tests to diagnose status acutely; rely on clinical assessment and recognition of mimics.
- Use EEG when motor activity has burned out and electrographic status is suspected.
Avoid Misdiagnosing Functional Seizures
- Actively distinguish functional (non-epileptic) seizures from epileptic status before giving benzodiazepines.
- Spend minutes calmly observing the seizure pattern and use video resources to learn the differences.
Practice Masterful Inactivity For Functional Attacks
- When you suspect non-epileptic attacks, practice "masterful inactivity": calm reassurance and minimal intervention.
- Senior clinicians must direct the team to avoid unnecessary drugs, oxygen, or escalation.