Status epilepticus is a very severe type of seizure.
For someone who has seizures, they”re normally similar in length each time they occur and typically stop once that time period has passed. Status epilepticus is the name given to seizures that don”t stop, or when one seizure comes after another without the person having time to recover.
Status epilepticus may be regarded as the most extreme form of epilepsy, or it may be a feature of a serious brain disorder. Such disorders include a stroke or inflammation of the brain tissue.
According to a 2012 review, Status epilepticus happens to up to 41 per 100,000 people per year.
Status epilepticus was given a new definition in 2015 as part of a revision of the classification of seizures. This is to help make diagnosing and managing seizures easier.
Previous definitions didn”t provide specific time points for when to treat Status epilepticus or when long-term side effects or complications were likely to begin.
The proposed new definition of Status epilepticus , published in the journal Epliepsia, is “a condition resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms, which lead to abnormally, prolonged seizures (after time point t1). It is a condition, which can have long-term consequences (after time point t2), including neuronal death, neuronal injury, and alteration of neuronal networks, depending on the type and duration of seizures.”
Time point t1 is the point at which treatment should begin. Time point t2 is the point at which long-term consequences may develop.
The time points differ depend on whether the person has convulsive or nonconvulsive Status epilepticus .
Convulsive Status epilepticus is the more common type of Status epilepticus . It occurs when a person has prolonged or repeated tonic-clonic seizures.
This is an intense epileptic seizure and can cause:
Convulsive Status epilepticus occurs when:
For the new proposed definition of Status epilepticus , time point t1 is five minutes, and time point t2 is 30 minutes.
Nonconvulsive Status epilepticus occurs when:
Nonconvulsive Status epilepticus symptoms are harder to recognize than convulsive Status epilepticus symptoms. The medical community doesn”t yet have specific time points for when to treat or when long-term consequences are likely to begin.
What causes Status epilepticus ?
Only about 25 percent of people who have seizures or Status epilepticus have epilepsy, according to the Epilepsy Foundation. But 15 percent of people with epilepsy will have an Status epilepticus episode at some point. It mostly happens when the condition isn”t well-managed with medications.
Most cases of SE happen to children under 15, especially in young children who have a high fever, and to adults over 40, with stroke leading to Status epilepticus late in life.
Other possible causes of Status epilepticus include:
How is it diagnosed?
Doctors may order the following to diagnose Status epilepticus :
Other possible tests include:
It can be difficult to diagnose nonconvulsive Status epilepticus because the condition may be mistaken for other conditions, such as psychosis and drug intoxication.
Treatment for Status epilepticus depends on whether the person is treated at home or in a hospital.
First-line treatment at home
If you”re treating a person having seizures at home, you must:
Call an ambulance for a person who has any type of seizure if:
Treatment in the hospital
First-line treatment in the hospital is likely to consist of:
IV phenobarbital or phenytoin may be given to suppress electrical activity in the brain and nervous system if IV lorazepam doesn”t work.
Hospital staff will also carry out any necessary emergency investigations, such as blood gases, renal function, liver function, AED levels, and calcium and magnesium.
Complications of Status epilepticus
People with SE have an increased risk of permanent brain damage and death. People with epilepsy also have a small risk of sudden unexpected death in epilepsy (SUDEP).
SE is considered to be a medical emergency and should be treated by medical professionals. But anyone can give emergency medications if they”re properly trained.
All people with epilepsy should have an individual care plan with a section on emergency medication. This should state:
The person with epilepsy should write the care plan with their doctor or nurse. This lets them give their informed consent to emergency treatment.