Boemo ba Epilepticus, Ho tsieleha ha nako e telele, le Tlhokomelo ea Pholoso ea Tšohanyetso¶

Status epilepticus ke boemo ba tšohanyetso ba methapo ea kutlo bo behang bophelo kotsing moo ho ts'oaroa ho nkang metsotso e 5 kapa ho feta, kapa ha motho a e-na le **ho oela habeli kapa ho feta ka morao ntle le ho tsoha le ho hlaphoheloa kelellong pakeng tsa bona **. Le hoja litlhaselo tse ngata tse sa rarahanang tsa sethoathoa li ikoalla ka nako ea 1 ho metsotso ea 2, ho ts'oaroa ha maikutlo ho fihla moeling oa metsotso ea 5 ho lahlehetsoe ke mokhoa oa tlhaho oa ho senya boko 'me ho ka baka ka potlako hyperthermia e feteletseng, ho hloka oksijene ea boko, lactic acidosis, ho senyeha ha mesifa, kotsi e sa feleng ea neuronal, le ho tšoaroa ke pelo. Ketso ea hang-hang ea motho ea emeng, ho qala setopotso motsotsong oa pele oa ts'ebetso ea ho ts'oaroa, ho sireletsa tsela ea moea sebakeng sa ho hlaphoheloa, ho letsetsa lits'ebeletso tsa bongaka tsa tšohanyetso ka nako ea metsotso e 5, le ho fana ka meriana ea pholoso ea nko, lerama (buccal), kapa rectal benzodiazepine ka nako, ke senotlolo sa ho emisa boemo ba lefu la sethoathoa pele ho tsoa kotsi ea boko.

Etsa sena hona joale¶

1. Sheba oache kapa mohala oa hau hang-hang 'me u qale nako hang hang ha ho tsietsana ho qala. Ho tseba hore na motho o tsietsana ka metsotsoana e 90 ho bapisoa le metsotso e 5 ho tla laola qeto e 'ngoe le e 'ngoe ea bongaka. Hlakola thepa ea ka tlung e thata kapa e nchocho hole le motho, mo theole fatše ka bonolo haeba a eme kapa a lutse, 'me u behe ntho e bonolo le e bataletseng (joaloka baki e mennoeng) ka tlas'a hlooho ea bona.
2. Letsa nomoro ea hau ea ts'ohanyetso ea sebakeng sa heno hang hang haeba tlhaselo e fihla metsotsong e 5, haeba ho ts'oaroa lekhetlo la bobeli pele ba tsoha, kapa haeba e le lekhetlo la pele ba ka oa. Letsetsa 911 United States le Canada, 112 ho pholletsa le European Union, 999 United Kingdom, kapa u bone tsohle. dinomoro tsa tshohanyetso. Hape letsetsa hang-hang ntle le ho emela metsotso ea 5 haeba motho a lemetse, a imme, a na le lefu la tsoekere, a le metsing, kapa a na le bothata ba ho hema ka mor'a hore ho thothomela ho khaotse.
3. Fana ka meriana ea pholoso e behiloeng ke motho (intranasal midazolam, intranasal diazepam, buccal midazolam, kapa rectal diazepam) ka letšoao la metsotso e 5 (kapa ho latela Leano la bona le ngotsoeng la Seizure Action Plan). Sheba mokotla oa bona, mokotlana oa hae, kapa thepa ea mohlokomeli bakeng sa sesepa sa nko se se se pakiloe esale pele (Naymidal) kapaNaytozilam [diazepam]), seringe ea molomo/buccal e tlatsitsoeng pele (Epistatus kapa Buccolam [buccal midazolam]), kapa seringe ea rectal (Diastat [rectal diazepam]). Latela litaelo tse nepahetseng tsa mohato ka mohato ka tlase; **Le ka mohla u se ke ua beha matlapa kapa mokelikeli molaleng oa motho ea hapiloeng kapa ea akhehileng **.
4. **Le ka mohla u se ke ua tšoara motho eo fatše 'me U SE KE UA kenya menoana, likhaba, lipache kapa ntho leha e le efe ka hanong. Ho qobella lintho pakeng tsa mehlahare e notletsoeng ho roba meno, ho phunya marinini le ho sutumelletsa lintho tse robehileng ka har'a pompong, ho baka ho bipetsoa ho kotsi.
5. Rollela motho lehlakoreng la hae hore a hlaphoheloe hang ha ho tsokotseha ho sa tsitsang ho lumella, 'me u lokolle liaparo tsa molala tse mo tiisang. Ho reteletsa motho eo lehlakoreng la hae ho lumella mathe, lekoeba, kapa mali a tsoang lelemeng le lohiloeng hore a tsoe hukung ea molomo ho e-na le ho huleloa matšoafong. Tlamola likonopo tsa melala ea hempe kapa lithae ebe o tlosa likhalase tsa mahlo.
6. **Sheba sefuba sa bona le ho hema ka ho tsoelang pele ka mor'a hore ho tsukutleha ho khaotse, 'me u batle "Non-Convulsive Status Epilepticus". Haeba ba emisa ho hema 'me ba se na pulse, qala CPR hang-hang; haeba 'mele ea bona e khaotsa ho sisinyeha ka matla empa mahlo a bona a lula a butsoe 'me a shebile ka ho sisinyeha ha leihlo le morethetho o poteletseng, ho otla ka molomo, kapa ho se arabele ka ho feletseng, bolella ba fanang ka thuso ea bongaka maemong a tšohanyetso hore boko ba bona bo ntse bo le **epilepticus ea boemo bo sa sisinyeheng **.

Boemo ba nako epilepticus le sefate sa qeto ea meriana ea pholoso¶

Sebelisa chate ena ea bongaka ho latela nako ea ho tsietsana, ho fana ka meriana ea pholoso ea lapeng kapa sekolong, le ho fetisetsa tlhokomelo ho baoki.

flowchart TD
    Start["Ho Qaleha ho Qala: Qala Nako ea Stopwatch Hang-hang<br/>Ho theola fatše habonolo, hlooho ea mosamo, khola e hlephileng, likotsi tse hlakileng<br/>U SE KE UA thiba kapa ua kenya letho hanong."] --> CheckTime{"Monitor Stopwatch Nako:<br/>Na ho tsieleha ho emisitse pele ho metsotso e 5<br/>(kapa pele ho Leano la Mosebetsi la mokuli)?"}

    CheckTime -->|"YES: E eme ka mor'a metsotso e 5"| PostIctalCheck{"Theohela ka lehlakoreng (Recovery Position)<br/>Na ho ts'oaroa ha BOBELI ho qala pele<br/>motho a tsoha ka mokhoa oa motheo?"}

    PostIctalCheck -->|"Ha ho na ho tsietsana lekhetlo la bobeli:<br/>Ho hema ka tloaelo le ho tsoha"| RoutineCare["Tlhokomelo e Tloaelehileng ea Post-Ictal Recovery:<br/>- Lula le mokuli a le boemong ba ho fola ho fihlela o falimehile ka botlalo<br/>- Letsetsa 911/112/999 ha feela motho a tsietsana ka lekhetlo la pele, a lemetse, a le moimana,<br/> ea lefu la tsoekere, ka metsing, kapa ho hema ho ntse ho sa tloaeleha."]

    PostIctalCheck -->|"YES: Back-to-back cluster seizures<br/>ntle le ho hlaphoheloa kelellong"| StatusAlert["STATUS EPILEPTICUS TIISETSOE:<br/>(E tswelapele >= 5 mets KAPA E ipheta ntle le ho fola)"]

    CheckTime -->|"CHE: Tšoaro e tsoela pele ka 5-Minute Mark<br/>(Nako Ntlha t1 e fihlile)"| StatusAlert

    StatusAlert --> CallAndGive["MELAO EA PHOLOSO EA HAMANE (Motsotso oa 5):<br/>1. Letsetsa 911/112/999 Hanghang<br/>2. Laola Mola oa Pele o Laetsoeng oa Benzodiazepine Rescue Med:<br/> - Intranasal Midazolam (Nayzilam) KAPA Intranasal Diazepam (Valtoco)<br/> - Buccal Midazolam (Buccolam / Epistatus) pakeng tsa lerama le marinini<br/> - Ge Rectal Diazepam"]

    CallAndGive --> TenMinCheck{"Ema 'me U Shebe U Phefumoloha (Metsotso 5 ho isa ho 10):<br/>Na ho tsietsana ho emisitse nakong ea metsotso e 5 ho isa ho e 10<br/>ea lethal dose la pele la pholoso?"}

    TenMinCheck -->|"YES: Jerk e emisa"| WatchSubtle{"Na mokuli o tsoha butle-butle,<br/>Kapa o ntse a akheha ka leihlo le poteletseng/ho tsikinyeha sefahlehong?"}
    WatchSubtle -->|"Ho tsoha, ho hema butle"| HandoverEMS["Boloka boemo ba ho hlaphoheloa, beha leihlo tsela ea moea,<br/>tlalehela ba fanang ka thuso ea bongaka maemong a tšohanyetso nako e nepahetseng ea ho tsietsana le tekanyetso"]
    WatchSubtle -->|"Comatose + kheloha e poteletseng ea mahlo/ho sisinyeha"| NCSEAlert["Motho ea belaelloang ka boemo ba Epilepticus (NCSE):<br/>Tsehetsa tsela ea moea, hlokomelisa EMS bakeng sa meriana e potlakileng ea sepetlele ea EEG & IV"]

    TenMinCheck -->|"NO: Ho tsieleha ho ntse ho tsoela pele ka metsotso e 10"| SecondDose["Boemo bo Thehiloeng Epilepticus:<br/>- Fana ka tekanyo ea pholoso ea 2 FEELA haeba u lumeletsoe ka ho hlaka morerong oa tlhokomelo<br/> (Le ka mohla u se ke ua fana ka > litekanyetso tsa 2 ka lebaka la kotsi ea ho tepella maikutlong)<br/>- Tšehetsa tsela ea moea/ho hema ho fihlela EMS e fana ka IV Levetiracetam/Fosphenytoin/Valproate"]

Ho utloisisa lintlha tse peli tsa bohlokoa tsa nako (\(t_1\) le \(t_2\)) tsa Status Epilepticus¶

Ho thusa batho ba emeng haufi, ba fanang ka thuso ea bongaka maemong a tšohanyetso, le lingaka tsa maemo a tšohanyetso ho utloisisa hore na ke hobane'ng ha motsotso o mong le o mong o le bohlokoa, Liki ea Machaba khahlanong le Sethoathoa (ILAE) e hlalosa boemo ba lefu la sethoathoa ka ho sebelisa lioache tse peli tsa ts'ebetso (Time Point \(t_1\) le Time Point \(t_2\)):

Hobaneng ho ema ho etsa hore lithethefatsi tsa pholoso li khaotse ho sebetsa: "GABA Receptor Internalization"¶

Bahlokomeli ba bangata ba ipotsa hore na ke hobane'ng ha ho fana ka nasal kapa buccal benzodiazepine ka **5 metsotso ** e sebetsa ho feta karolo ea 80 lekholong ea bakuli, athe ho fana ka meriana e tšoanang hantle ka ** 20 kapa 30 metsotso ** hangata ho hlōleha ka ho feletseng. Karabo e ho cellular neurobiology: - Benzodiazepines (midazolam, diazepam, and lorazepam) e emisa ho tsietsana ka ho tlamella ho thibela \(\text{GABA}_\text{A}\) receptors holim'a methapo ea boko, e pompa li-ion tsa chloride liseleng ho khutsisa sefefo sa motlakase. - Leha ho le joalo, kamora metsotso e 5 ho isa ho e 10 ea hthunya ho sa khaotseng , li-neurone tsa boko li hula lzzwxh:0009 li-receptors holim'a sele ebe li li pata ka har'a sele (receptor endocytosis / internization **), ha ka nako e le 'ngoe li sutumelletsa ho feta NMDA le AMPA glutamate cell cell. - Consequently, every 5-minute delay in administering first-line benzodiazepine rescue therapy cuts the drug's effectiveness and allows the seizure to lock into Established Status Epilepticus (which requires heavy hospital intravenous infusions of levetiracetam, fosphenytoin, or valproate) or Refractory Status Epilepticus (requiring intensive care general anesthesia and mechanical ventilation).

How prolonged convulsive seizures harm the body: The two-phase systemic crisis¶

When a generalized tonic-clonic seizure continues past 5 minutes without stopping, the entire body undergoes a violent two-stage physiological crisis:

Phase 1: The Hyperdynamic / Sympathetic Storm (Minutes 0 to 30)¶

During the first 5 to 30 minutes of continuous muscle convulsions: 1. Massive Catecholamine Surge: Epinephrine and norepinephrine levels skyrocket, driving heart rate above \(150\text{ to }180\text{ bpm}\), spiking systolic blood pressure above \(200\text{ mmHg}\), and spiking intracranial pressure inside the skull. 2. Apnea, Hypoxia, and Severe Lactic Acidosis: Because the chest wall muscles and diaphragm are locked in tonic-clonic spasms, the patient cannot breathe effectively while their muscles consume enormous amounts of oxygen. Arterial blood \(\text{pH}\) plummets below \(7.00\) due to combined respiratory and lactic acidosis. 3. Neurogenic Hyperthermia and Rhabdomyolysis: Relentless full-body muscle contraction heats core body temperature above \(40.0^\circ\text{C}\) (\(104.0^\circ\text{F}\)) (which directly cooks brain cells in the hippocampus and cerebellum) and shreds skeletal muscle fibers (rhabdomyolysis). Shredded muscle dumps myoglobin (which causes acute kidney failure) and potassium (hyperkalemia, which can trigger fatal cardiac arrhythmias) into the bloodstream.

Mokhahlelo oa 2: Mokhathala oa 'Mele le Phallo ea Motlakase (Kamora Metsotso ea 30)¶

Haeba ts'oaetso e tsoela pele ho feta metsotso e 20 ho isa ho e 30 e sa phekoloe, matšeliso a 'mele a hlōleha: - Cerebral Autoregulation Collapse and Hypotension: Blood pressure suddenly drops while the epileptic brain neurons are still demanding 300 percent of normal blood flow, starving the brain of oxygen and glucose (hypoglycemia). - Motor Exhaustion ("Subtle Status"): The patient's muscles run out of energy and stop thrashing violently, misleading bystanders into thinking the seizure is over, even while electrical status epilepticus continues firing at full force inside the cortex.

Comparing Convulsive Status vs. Non-Convulsive Status vs. Functional/Dissociative Seizures¶

Ha se karolo e 'ngoe le e 'ngoe ea nako e telele ea ho thothomela kapa ho se arabele e tšoanang. Sebelisa tafole ena ea papiso ea litleleniki ho lemoha mekhoa e meraro e meholo e bonoang maemong a tšohanyetso a pele ho sepetlele:

Step-by-step guide: How to administer prescribed benzodiazepine rescue medications¶

Patients with known epilepsy, febrile seizures, Dravet syndrome, or Lennox-Gastaut syndrome are frequently prescribed an out-of-hospital benzodiazepine rescue medication accompanied by a physician-signed Seizure Action Plan. Because swallowing is impossible during a seizure, these medications are absorbed across the rich blood vessels inside the nose (intranasal), cheek cavity (buccal), or rectum (rectal).

Quick comparison of the four standard out-of-hospital rescue routes¶

Mokhoa oa 1: Mokhoa oa ho fana ka Intranasal Midazolam (Nayzilam) kapa Intranasal Diazepam (Valtoco)¶

1. Sheba Leano la Ketso la ho Khutsa 'me u hlahlobe sephutheloana sa blister. Netefatsa tekanyetso e behiloeng 'me u netefatse hore na lebokose le na le sesebelisoa se le seng sa ho fafatsa nko (\(5\text{mg}\) Nayzilam, kapa \(5\text{ mg} / 7.5\text{ mg} / 10\text{mg}\) Valtoco) kapa sesebelisoa tse peli tsa nasal{{text$ \(2\)* \(1\)* lisebelisuoa tse peli tsa nko* mg}$ Valtoco, moo sesebelisoa se seng le se seng se tšoereng halofo ea tekanyo ea kakaretso).
2. Bula lehlaseli la foil 'me u tlose yuniti ea spray ea nko. Tšoara sesebelisoa ka monoana o motona tlase ho plunger le menoana ea hau ea index le e bohareng mahlakoreng ka bobeli a molomo.
3. BOHLOKOA: U SE KE UA qala kapa ho etsa teko-hatsa sesebelisoa moeeng. Ho fapana le likheo tsa ho hanana le linako tsa nko, li-spray tsa nko tsa tšohanyetso li na le **thal dose e le 'ngoe e lekantsoeng **. Ho hatella seqhomane pele o kenya molomo oa nko ka har'a nko ea motho ho senya moriana o pholosang bophelo moeeng.
4. Tshehetsa hlooho ea motho eo 'me u kenye ntlha ea molomo ka har'a nko e le 'ngoe. Ka bonolo u tsitsitse mokokotlo kapa lehlakore la hlooho ea motho ka letsoho la hao le lokolohileng e le hore ho tsokoa ka tšohanyetso ho se ke ha hula nko ea hae. Kenya ntlha ea molomo ka har'a nko e le 'ngoe ho fihlela menoana ea hau e lutse holim'a nko ea mokuli. (Haeba nko e ’ngoe e koetsoe ke mamina kapa mali, sebelisa e ’ngoe ea nko.)
5. Tobetsa plunger e ka tlase ho ea holimo ka monoana oa hao o motona ka ho sisinyeha hanngoe. Mokuli HA HO HLOKE HO hema kapa ho hema hore moriana o sebetse; moholi o koahela lesela la nko ebe o monya ka ho toba maling.
6. Haeba o fana ka tekanyetso ea 15 mg kapa 20 mg ea lisebelisoa tse peli tsa Valtoco: Bula hang-hang sephutheloana sa bobeli sa blister 'me u fafatse sesebelisoa sa bobeli ka nkong e MONG hore nko ka 'ngoe e fumane sefafatsi se le seng.
7. Ela hloko nako e nepahetseng e fanoeng 'me u boloke motho ea ka lehlakoreng la hae a le boemong ba ho hlaphoheloa. U se ke ua butsoela kapa ua hlakola ka hare ho linko tsa bona ka mor'a ho fafatsa.

Mokhoa oa 2: Mokhoa oa ho fana ka Buccal Midazolam (Buccolam kapa Epistatus seringe ea molomo e tlatsitsoeng pele)¶

Buccal midazolam ke meriana e tloaelehileng ea pholoso ea malapeng le sekolong ho pholletsa le United Kingdom, European Union, le Australia, e sebelisa lisyringe tsa polasetiki tse tlatsitsoeng ka mebala (Yellow = \(2.5\text{ mg}\) [likhoeli tse 3 ho isa ho tse 11]; Boputsoa = \(5\text{mg}\) [1 ho isa ho lilemo tse 4]; **Purple*year = $5 mg = $7. Namune/Kgubedu = \(10\mongolo{mg}\) [lilemo tse 10 ho isa ho tse 17 le batho ba baholo]).

1. *Etsa bonnete ba hore motho o robetse ka lehlakore ha a ntse a fola. Ho fana ka mokelikeli oa buccal motho a ntse a le ka lehlakoreng la hae ho etsa bonnete ba hore metsi a phalla ka mokhoa o sireletsehileng ka mokotleng o ka tlaase oa lerama ho e-na le ho rothela ka morao molaleng.
2. Tlosa serinji ea polasetiki tšupung ea eona e sireletsang 'me u hule kepisi. Sheba hore na kepisi e nyane e ka hare e benyang e tlohile ka ho feletseng le kepisi e le hore e se ke ea sutumetsoa ka hanong ka phoso. Se ke oa hokela nale (ena ke serinji ea molomo e se nang nale).
3. Ka bonolo hula molomo o ka tlaase oa motho ka lehlakoreng le haufi le fatše. Le ka mohla u se ke ua leka ho bula meno a koalehileng. Meriana e tsoela ka ntle meno, sebakeng (buccal cavity) pakeng tsa bokantle ba marenene a ka tlaase le bokahare ba lerama le ka tlaase.
4. *Kenya ntlha ea serinji sebakeng se pakeng tsa bokahare ba lerama le ka tlaase.
5. Bula butle-butle ka plunger ho feta metsotsoana e 2 ho isa ho e 3 ho petetsa hoo e ka bang HALF ea mokelikeli ka mokotleng o ka tlaase oa lerama, ebe u petetsa halofo e setseng ka mokotleng o mong oa lerama (kapa butle-butle ka mokotleng o tšoanang o ka tlaase haeba ho le thata ho thinya). Ho tsamaea butle ho thibela mokelikeli ho phalla le ho metsoa kapa ho tšoeloa; buccal midazolam e sebetsa ka potlako ho makgetlo a mahlano ha e monyela ka lerameng ho feta ha e metsoa ka mpeng.
6. Haeba mokelikeli o monyane o tsoa molomong, SE KE UA fana ka serinji e eketsehileng e sa ngoloang. Ngola nako e tobileng eo lethal dose e fanoeng ka eona 'me u fane ka serinji e se nang letho ho baoki.

Mokhoa oa 3: Mokhoa oa ho fana ka Gel ea Rectal Diazepam (Diastat AcuDial)¶

1. Rollela motho eo lehlakoreng la hae a shebane le wena mme o koba lengole la hae le ka hodimo pele. Theola borikgwe ba hae le diaparo tsa ka hare tse lekaneng ho pepesa dibono.
2. ** Netefatsa fensetere ea tekanyetso ho sering ea Diastat AcuDial 'me u tlose kepisi e sireletsang.** Tiisa hore sehlopha se setala "READY" sea bonahala 'me fensetere ea tekanyo e notletsoeng e lumellana le lengolo la ngaka.
3. Tlotsa ntlha e boreleli ea polasetiki ea mokokotlo. Tabola pakete ea jelly e tlotsang e kenyellelitsoeng lebokoseng la lipakete tse peli 'me u apese ntlha ea polasetiki hantle.
4. Arola libono ka bonolo 'me u kenye ntlha e tlotsitseng ka har'a rectum ho fihlela rim e lula hantle khahlano le lesoba le leso. (Bakeng sa bana ba ka tlase ho lilemo tse 3, kenya halofo feela.)
5. Bala butle-butle "Sekete-kete-kete-kete-kete-kete-kete-kete-kete-kete-kete-kete-kete-kholo-kholo-kholo-kholo-kholo-kete-kete-kete-kete-kete-kete-kete-kete-kete-kete-kete-kete-kete-kete-kete-kete-kete-kete-kete-kete-kete-kete-kete" ha u ntse u sututsa plunger ho kena hohle.
6. Bala butle ho isa ho 3 hape PELE u thellela ntlha e tsoang ka har'a rectum, joale hang-hang u pinye libono ka metsotsoana e meng e 3. Ho petetsa marako hammoho ho thibela gel hore e se ke ea tsoa nakong ea ho honyela ha mesifa. Tlohela motho ka lehlakoreng la bona sebakeng sa ho hlaphoheloa 'me u hlokomele nako e tobileng.

Melao ea ho pheta-pheta litekanyetso le ho beha leihlo bakeng sa khatello ea maikutlo ea ho hema¶

• Le ka mohla u se ke ua fana ka tekanyo ea bobeli pele ho nako: Ema bonyane 5 ho isa ho metsotso e 10 ka mor'a tekanyo ea pele (metsotso e 10 bakeng sa Nayzilam kapa Buccolam; hlahloba Leano la Mokuli le ngotsoeng hantle le ngotsoeng ke Seizure).
• Never give more than 2 total benzodiazepine doses outside a hospital: Giving a second or third benzodiazepine dose dramatically increases the risk of respiratory depression (slow, shallow, or stopped breathing). Even if the patient's Seizure Action Plan authorizes a second dose at 10 minutes, do not give a second dose if their breathing is already dangerously slow (\(< 8\text{ to }10\text{ breaths per minute}\)) or shallow.
• Watch the chest continuously after giving any rescue medication: Keep a hand on their shoulder and watch their chest rise and fall until paramedics take over. If they stop breathing, open the airway with a gentle head-tilt/chin-lift (or jaw thrust if neck injury is suspected) and begin rescue breathing / CPR.

Special high-risk scenarios: Febrile Status Epilepticus, Pregnancy (Eclampsia), and Trauma¶

1. Febrile Status Epilepticus in infants and young children (Ages 6 months to 5 years)¶

While simple febrile seizures in toddlers last only 1 to 2 minutes and are harmless, roughly 5 to 8 percent of febrile seizures last longer than 5 to 30 minutes (Febrile Status Epilepticus). - Immediate action: Start a timer, place the child on their side on a cool flat surface, remove heavy blankets or winter coats, and call 911 / 112 / 999 at the 5-minute mark. - Never put a seizing child in a cold bath or rub them with alcohol: Cold water causes violent shivering and peripheral vasoconstriction that actually traps heat inside the core and creates a drowning hazard. - Look for meningitis or encephalitis red flags: Alert paramedics immediately if the child had a stiff neck, extreme sensitivity to light, a non-blanching purple/red pinpoint rash (petechiae), or a bulging soft spot (fontanelle) before the seizure began.

2. First-time seizure in late pregnancy or postpartum: Assume Eclampsia¶

If a pregnant person past 20 weeks of gestation (or a new mother up to 6 weeks after childbirth) has a generalized tonic-clonic seizure and has no known history of epilepsy, assume life-threatening Eclampsia until proven otherwise: - Call 911 / 112 / 999 immediately at the very first second of the seizure (do not wait 5 minutes) and declare "Suspected Eclamptic Seizure in Pregnancy." - Position in the Left Lateral Tilt (Left Side): Roll the pregnant person onto her left side (or place a firm pillow under her right hip to tilt the uterus 15 to 30 degrees to the left) so the heavy pregnant uterus does not crush the inferior vena cava vein and starve the mother's heart and the baby of blood. - Hospital note: Eclamptic seizures are treated in the ambulance or hospital with intravenous or intramuscular magnesium sulfate (\(4\text{ to }6\text{ gram}\) loading dose), rather than standard anti-epileptic drugs alone, paired with urgent blood pressure control.

3. Prolonged seizures caused by reversible metabolic or toxic triggers¶

Paramedics arriving at a status epilepticus scene immediately check for reversible "non-epileptic" triggers that require a specific antidote alongside benzodiazepines. Tell the ambulance crew right away if any of these apply: - Severe Hypoglycemia (Low Blood Sugar): Every patient in status epilepticus gets an immediate fingerstick blood glucose check by EMS; if blood sugar is below \(3.3\text{ to }3.9\text{ mmol/L}\) (\(60\text{ to }70\text{ mg/dL}\)), intravenous dextrose stops the seizure instantly. - Acute Hyponatremia (Water Intoxication): Common in endurance marathon runners who drank liters of plain water, MDMA (ecstasy) users, or infants fed diluted formula; requires hospital hypertonic \(3\%\) saline. - Toxic Overdose or Withdrawal: Abrupt withdrawal from heavy alcohol or daily benzodiazepines (Xanax, Valium, Ativan), or overdose of tricyclic antidepressants, bupropion (Wellbutrin), isoniazid (requires intravenous pyridoxine / Vitamin B6), cocaine, or organophosphate pesticides.

Lipotso tse botsoang khafetsa¶

Why did the definition of status epilepticus change from 30 minutes down to 5 minutes?¶

Although irreversible brain cell injury begins around 30 minutes of continuous convulsive seizing, clinical studies proved that any generalized tonic-clonic seizure lasting 5 minutes or longer has already lost its natural ability to stop on its own. In addition, after 5 to 10 minutes of continuous firing, brain cells pull their GABA receptors inside the cell where benzodiazepine rescue drugs cannot reach them; treating at the 5-minute mark stops over 80 percent of prolonged seizures before drug resistance and brain damage develop.

Can I accidentally choke someone by giving them buccal midazolam liquid inside their cheek during a seizure?¶

No, when buccal midazolam is given properly with the person lying on their side in the recovery position and squirted slowly into the lower pocket between the outside of the lower gum and the inner cheek, it does not cause choking. The small volume of liquid (usually 0.5 to 2 milliliters) coats the rich blood vessels of the inner cheek lining and absorbs directly into the bloodstream without needing to be swallowed.

Does a seizing person need to inhale or sniff when I spray intranasal midazolam (Nayzilam) or diazepam (Valtoco) into their nostril?¶

No, the person does not need to inhale, sniff, or even be breathing deeply for intranasal seizure sprays to work. The spray nozzle turns the medication into a fine mist that coats the vascular mucous membranes inside the nasal cavity (not the lungs), absorbing directly into the venous blood supply within 2 to 5 minutes.

What should I do if a person stops shaking after 4 minutes, but 25 minutes later they still have not woken up at all?¶

Call your local emergency number (911, 112, or 999) immediately if you have not already done so, and inspect their eyes and face closely. While 15 to 30 minutes of deep post-ictal sleep is common after a major seizure, failure to show any gradual awakening after 20 to 30 minutes (especially if accompanied by open staring eyes, subtle rhythmic eyeball twitching, or tiny facial twitches) is a critical red flag for Non-Convulsive Status Epilepticus, meaning the electrical seizure is still firing inside the brain without visible muscle convulsions.

Mehloli e hlahlobiloe¶

• American Epilepsy Society (AES, United States): Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society (Glauser et al., Epilepsy Currents, defining the 0-5 minute stabilization phase and 5-20 minute benzodiazepine phase).
• International League Against Epilepsy (ILAE): A Definition and Classification of Status Epilepticus: Report of the ILAE Task Force on Classification of Status Epilepticus (Trinka et al., Epilepsia, establishing Time Points \(t_1\) [5 minutes] and \(t_2\) [30 minutes]).
• National Institute for Health and Care Excellence (NICE, United Kingdom): Epilepsies in Children, Young People and Adults (NICE Guideline NG217, community buccal midazolam and rectal diazepam protocols for prolonged or repeated seizures at 5 minutes).
• Neurocritical Care Society (United States) and European Academy of Neurology (EAN): Guidelines for the Evaluation and Management of Status Epilepticus (including subtle/non-convulsive status epilepticus recognition and refractory pathways).
• Epilepsy Foundation (United States) and Epilepsy Society / Epilepsy Action (United Kingdom): Seizure First Aid ("Stay, Safe, Side") and Rescue Medication Training Guidelines for Nayzilam, Valtoco, Buccolam, Epistatus, and Diastat.

Litataiso tse amanang¶

• Seizures: general first aid and recovery position
• Cardiopulmonary resuscitation (CPR) and AED guide
• Head injuries and concussion red flags
• Diabetic emergencies: hypoglycemia and immediate glucose rescue
• Stroke recognition (FAST) and emergency response