Paging the MDs: ? about seizures...

[VunderBob]

I had an ambulance call this weekend for a patient who would not quit seizing. She’d have a about a minute long grand mal, stop briefly, have one or 2 smaller seizures, stop for a minute or so, and repeate on about a 5 or 6 minute cycle. She came off the stretcher twice, and this continued for most of the half-hour trip to the hospital.

I was taught that with true epilepsy you’d have one big seizure, maybe a smaller aftershock seizure, and be done; repeated seizures were indicitive of something else such as a tumor or recreational pharmacuetical use. The patient had no known history of epilepsy, and the scene was at a large party, so there’s a chance recreation was involved. If this was caused by drug use, which ones are likely to trigger such an episode?

Disclaimers: I’m asking for idle speculation, not a diagnosis. I will not add any more details for fear of HIPAA violation. Offer void where prohibited.

[Chief_Pedant]

There are lots of causes for acute intractable tonic-clonic seizures, as you know, and lots of toxic causes in particular. Cocaine, PCP and amphetamines come to mind as reasonably high on the list for your scenario.

[groman]

@Chief Pedant

There are lots of causes for acute intractable tonic-clonic seizures, as you know, and lots of toxic causes in particular. Cocaine, PCP and amphetamines come to mind as reasonably high on the list for your scenario.

Am I imagining things or is this also what happens after a few grams of caffeine?

[USCDiver]

VunderBob the term you’re looking for is Status Epilepticus. From eMedicine

@eMedicine

Traditionally, status epilepticus was defined as 30 minutes of continuous seizure activity or a series of seizures without return to full consciousness between the seizures.

bolding mine

True status epilepticus as you describe in your OP is definitely NOT limited to recreational drug use and you should be careful about letting your focus become too narrow in cases like these. The eMedicine article has some information about toxins that can possibly cause ‘Status’ as well as general Pre-hospital care if you’re interested.

In case you don’t want to click through here is their list of causes (certainly not exhaustive):

@eMedicine

Causes: The causes of status epilepticus represent an imperfect division into 3 groups.
[ul]
[li]In roughly one third of cases, an exacerbation of an idiopathic seizure disorder is thought to be the cause (this is a diagnosis of exclusion).[/li][li]In another one third of cases, the episode of status represents the first onset of a seizure disorder (a diagnosis of exclusion).[/li][li]A myriad of other conditions may precipitate status epilepticus, including toxic or metabolic causes and anything that might cause cortical structural damage.[/li][list][li]Stroke (remote or acute)[/li][li]Hypoxic injury[/li][li]Tumor[/li][li]Subarachnoid hemorrhage[/li][li]Trauma[/li][li]Toxicologic etiology (eg, cocaine, theophylline, isoniazid, alcohol withdrawal)[/li][li]Electrolyte abnormalities (eg, hyponatremia, hypernatremia, hypercalcemia, hepatic encephalopathy)[/li][li]Infectious etiology (eg, meningitis, brain abscess, encephalitis)[/li][/ul][/list]

[VunderBob]

@USCDiver

True status epilepticus as you describe in your OP is definitely NOT limited to recreational drug use and you should be careful about letting your focus become too narrow in cases like these. The eMedicine article has some information about toxins that can possibly cause ‘Status’ as well as general Pre-hospital care if you’re interested.

FWIW, on that particular run I did the driving, not patient care. There were 2 well seasoned EMT-Is doing that vs. me as a n00b -B, so she was well taken care of. I was asking out of curiosity, because they brought up the possible drug use after the run was over.

It was THAT kind of party, BTW…

[Nutty_Bunny]

IANAD, but I agree about the recreational drug use, based on experience. A few years ago, I took too much Ultram (tramadol) and had a seizure. After admitting my addiction and I got to detox, the tramadol showed up as PCP in my urine.

Yes, explore other possibilities, but I wanted to give you anectodal evidence of drug use being one of the possible causes.