STATUS EPILEPTICUS
Last Updated : 1/3/2011
Swati Joshi
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Status epilepticus (SE)

is a neurologic emergency associated with significant mortality and morbidity.

Definition:

Conventionally defined as " prolonged seizure activity lasting longer than 30 min or series of seizures without recovery of consciousness in the interim".

The term refractory SE is used when there is failure to respond to first line drugs and seizures persist for more than 60 minutes.

Early recognition of SE is of utmost importance because longer the SE, the more difficult the control and more the risk of neurologic sequelae. Therefore, SE should be considered and treatment initiated when patient presents in emergency with continuous seizures or series of seizures without recovery of consciousness lasting 10 or even 5 min.

Incidence:

SE is more common in children (more often in less than 3 yr olds) than adults with frequency of around 3.7%.

Any seizure type can present as SE. Generalised tonic clonic is the most common form and also the one with highest mortality and morbidity.

International classification is as follows:


Convulsive (generalized) SE


- Tonic clonic
- Tonic
- Clonic
- Myoclonic

Non-convulsive


- Absence status
Partial SE
- Simple partial SE epilepsia partialis continua/ other types
- Complex partial status
Unilateral SE
- hemiclonic status
- hemiconvulsion hemiplegia syndrome

Etiology of SE
There are three main situations in which SE can present:
Acute situation related:
- CNS infections: meningitis, encephalitis
- Acute anoxic insult
- Metabolic: hypoglycemia, inborn errors of metabolism (IEM), Reye syndrome
- Electrolyte imbalance
- CNS trauma/ haemorrhage/tumors
- Drugs, intoxications, poisoning
- Hypoxic ischemic encephalopathy and IEM in newborn period
First unprovoked seizures presenting as SE - most commonly febrile status
SE in patients with epilepsies: epileptics on irregular treatment, sleep deprivation, intercurrent infections and symptomatic epilepsies are more prone to developing SE.



Contributor Information and Disclosures

Swati Joshi
Consultant Neurologist, Indore, India.


First Created : 1/4/2001

References

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