Status epilepticus

Status epilepticus (SE) is a single epileptic seizure lasting more than five minutes or two or more seizures within a five-minute period without the person returning to normal between them. Previous definitions used a 30-minute time limit. The seizures can be of the tonic–clonic type, with a regular pattern of contraction and extension of the arms and legs, or of types that do not involve contractions, such as absence seizures or complex partial seizures. Status epilepticus is a life-threatening medical emergency particularly if treatment is delayed. Status epilepticus (SE) is a single epileptic seizure lasting more than five minutes or two or more seizures within a five-minute period without the person returning to normal between them. Previous definitions used a 30-minute time limit. The seizures can be of the tonic–clonic type, with a regular pattern of contraction and extension of the arms and legs, or of types that do not involve contractions, such as absence seizures or complex partial seizures. Status epilepticus is a life-threatening medical emergency particularly if treatment is delayed. Status epilepticus may occur in those with a history of epilepsy as well as those with an underlying problem of the brain. These underlying brain problems may include trauma, infections, or strokes among others. Diagnosis often involves checking the blood sugar, imaging of the head, a number of blood tests, and an electroencephalogram. Psychogenic nonepileptic seizures may present similarly. Other conditions that may also appear to be SE include low blood sugar, movement disorders, meningitis, and delirium among others. Benzodiazepines are the preferred initial treatment after which typically phenytoin is given. Possible benzodiazepines include intravenous lorazepam as well as intramuscular injections of midazolam. A number of other medications may be used if these are not effective such as valproic acid, phenobarbital, propofol, or ketamine. Intubation may be required to help maintain the person's airway. Between 10 and 30% of people who have status epilepticus die within 30 days. The underlying cause, the person's age, and the length of the seizure are important factors in the outcome. Status epilepticus occurs in up to 40 per 100,000 people per year. It makes up about 1% of people who visit the emergency department. Status epilepticus can be divided into two categories: convulsive and nonconvulsive (NCSE). Convulsive status epilepticus presents with a regular pattern of contraction and extension of the arms and legs. Epilepsia partialis continua is a variant involving hour-, day-, or even week-long jerking. It is a consequence of vascular disease, tumors, or encephalitis, and is drug-resistant. Generalized myoclonus is commonly seen in comatose people following CPR and is seen by some as an indication of catastrophic damage to the neocortex. Refractory status epilepticus is defined as status epilepticus that continues despite treatment with benzodiazepines and one antiepileptic drug. Super-refractory status epilepticus is defined as status epilepticus that continues or recurs 24 hours or more after the onset of anaesthetic therapy, including those cases where status epilepticus recurs on the reduction or withdrawal of anesthesia.