Status epilepticus

Status epilepticus (SE), or status seizure, is a medical condition characterized by a prolonged period of seizure activity without a complete return to normal. It is a medical emergency that can lead to irreversible brain injury (due to excitotoxicity) if untreated.

Convulsive status epilepticus, the most dangerous and life-threatening type, is characterized by seizures of the tonic–clonic type, with a regular pattern of contraction and extension of the arms and legs, lasting at least 5 minutes without return to normal (time point 1). Early treatment is essential to minimize damage to the brain, which starts to particularly accrue after 30 minutes (time point 2). Status epilepticus may also be non-convulsive, manifesting in the form of absence seizures or complex partial seizures. For other seizure types, the time points may vary. Previous definitions used a 30-minute time limit irrespective of type of seizure.

Risk factors for status epilepticus include a history of epilepsy or other brain problems. These 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 to status epilepticus. Other conditions that can mimic status epilepticus include low blood sugar, movement disorders, meningitis (including tuberculous 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 phenobarbital, propofol, or ketamine. After initial treatment with benzodiazepines, typical antiseizure drugs are given, including valproate, fosphenytoin, levetiracetam, or similar substances. 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 prognosis. Status epilepticus occurs in up to 40 per 100,000 people per year. Those with status epilepticus make up about 1% of people who visit the emergency department.