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Short answer question case series: treatment of persistent, refractory seizures
  1. Paul Rohdenberg,
  2. Pranav Shetty,
  3. Timothy Jang
  1. Department of Emergency Medicine, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Torrance, California, USA
  1. Correspondence to Dr Timothy B Jang, Department of Emergency Medicine, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, 1000 W Carson St, Torrance, CA 90509, USA; tbj{at}ucla.edu

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Case vignette

An 18-year-old woman presents with persistent seizures. She is compliant with her medication, but had a generalised tonic-clonic seizure yesterday. Today, she had multiple seizures over a 2 h period without a return to baseline. On arrival, she had tonic-clonic movements of her right arm and leg with eye deviation to the left. Her vital signs were blood pressure 120/80 mm Hg, pulse 110 beats/min, respiration 18 breaths/min, O2 saturation 93% on room air.

Key questions

  1. What should be done for this patient?

  2. What therapeutic interventions should be performed?

  3. What is the appropriate disposition for this patient?

Discussion

1. The first priority is to ensure cardiopulmonary stability. She should be given supplemental oxygen, a thorough airway evaluation, and airway management as needed. Immediate vascular access must be obtained and blood glucose checked. Hypoglycaemia is a common treatable cause of seizures and altered mental status. Further, fluids and antiepileptic drugs should be started. A pregnancy test should be checked as management would change significantly if positive.

2. This patient received a total of 12 mg of intravenous lorazepam (2 mg×2 and 4 mg×2). She responded initially and the seizures stopped. In total, she had three seizures in the emergency department, four seizures at home and had not returned to baseline over a …

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