Status Epilepticus

Status epilepticus is a life-threatening condition defined as a seizure lasting longer than five minutes that does not stop on its own and from which the patient does not wake. In the U.S., approximately 120,000-180,000 cases of status epilepticus occur each year. The condition affects people of all ages, but is more prevalent in young children and elderly people. Status epilepticus can permanently affect cognitive abilities, cause brain damage and even death.

Patients may experience either convulsive or nonconvulsive status epilepticus. Convulsive epilepticus is when a patient physically convulses during a seizure and is unconscious. This is the more common type of status epilepticus and is considered a medical emergency. If convulsive epilepticus is suspected, medical attention should be sought immediately so that the proper medicine can be administered to mitigate damage and risk of death.

Nonconvulsive status epilepticus is often more difficult to identify as the seizure may not be physically obvious. Often during a nonconvulsive status epilepticus seizure, the person may appear confused, foggy or absent but not unconscious. If a nonconvulsive status epilepticus is suspected, medical treatment should also be sought immediately. An EEG may be required to confirm the condition.

Symptoms

Status epilepticus is defined as a prolonged seizure, either one seizure that lasts longer than five minutes or two or more consecutive seizures where the person does not fully regain consciousness between each episode. A convulsive epilepticus seizure occurs when the patient physically convulses and loses consciousness. A nonconvulsive epilepticus patient will not lose consciousness but may seem confused or absent.

Causes

The underlying cause of status epilepticus varies, but is generally considered to occur when the mechanism to stop a seizure in the brain stops functioning. The biggest risk factor for status epilepticus is a history of epilepsy, and 15% of epilepsy patients will experience a status epilepticus episode in their lifetime. Other causes include a brain tumor, infection in the brain, cerebrovascular disease or head trauma.

Diagnosis

If a status epilepticus is suspected, medical attention should be sought immediately. Nonconvulsive status epilepticus patients may receive an EEG test to confirm diagnosis. When a status epilepticus seizure occurs, the degree of neurological damage is closely related to the duration of the seizure.

Treatment

Status epilepticus is life threatening and considered an emergency situation and patients should seek help immediately. In all cases of status epilepticus, the best possible outcomes correlate with a swift diagnosis and administration of treatment to stop the seizure. Status epilepticus is treated with a variety of medications including:

• Medication: Benzodiazepine is the most common pharmaceutical given to stop a status epilepticus seizure followed by fosphenytoin if necessary. Approximately one third of patients will not respond to the first line of medications and may receive additional treatment including barbiturates or propofol.
• Surgery: In a small amount of cases where seizures do not respond to medical management, surgical intervention may be considered if a surgically resolvable lesion is identified.
• Ongoing management: Clinicians may also treat the underlying cause of status epilepticus, if it is able to be identified. Causes may include AED therapy noncompliance, acute infections or high fever.

Additional Resources

• Baylor College of Medicine, Texas Children’s Hospital study will look at best treatment for prolonged seizures
• National Institute of Health – Status Epilepticus