بِسْمِ اللَّـهِ الرَّحْمَـٰنِ الرَّحِيمِ الَّذِي خَلَقَنِي فَهُوَ يَهْدِينِ وَالَّذِي هُوَ يُطْعِمُنِي وَيَسْقِينِ وَإِذَا مَرِضْتُ فَهُوَ يَشْفِينِ
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هو انا لو بعالج ال status Epilepticus

سواء بفينتوين أو تيراتام امبول لمدة مثلا يوم او يومين لازم برضو أوقف الادوية ديه بالتدريج ما ينفعش أوقف العلاج مؤة واحدة يعني وخاصة لو مكنش بياخد الادوية ديه قبل كده واقول الجرعة بمقدار قد ايه وع كام يوم

Hossam Elgnainy Selected answer as best May 22, 2024
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This will be a difficult one to answer as how to and if you have to slowly withdraw a medication can be different from patient to patient and from drug to drug. But generally speaking, the withdrawal is usually guided by the EEG monitoring and clinical monitoring.

If we are talking about “refractory generalised convulsive status epilepticus”, maintain seizure control (based on EEG) for 24 to 48 hours before initiating slow withdrawal of continuous infusions.

Other guidelines recommend 12 to 24 hours;

Once seizures have been controlled for 12-24 hours, continuous intravenous therapy should be gradually tapered off if the drug being administered is midazolam or propofol. Gradual tapering is probably not necessary with pentobarbital or thiopental sodium. Continuous EEG monitoring is required during high-dose treatment and while therapy is gradually withdrawn. During withdrawal of anaesthetic therapy, intravenous phenytoin/fosphenytoin or valproate should be continued (these agents having been administered during earlier phases of GCSE) to ensure an adequate baseline of antiepileptic medication so as to prevent the recurrence of status epilepticus.

  • Kälviäinen R, Eriksson K, Parviainen I. Refractory generalised convulsive status epilepticus : a guide to treatment. CNS Drugs. 2005;19(9):759-68. doi: 10.2165/00023210-200519090-00003. PMID: 16142991.
Hossam Elgnainy Selected answer as best May 22, 2024
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