Status Epilepticus

• A practical definition of status epilepticus (SE) is any seizure lasting longer than 5 minutes without interruption.  Seizures that last this long are unlikely to stop spontaneously without medical intervention

• 50,000 person die of SE in the United States per year

• A life-threatening emergency depending on the context and type.  The most common forms of SE are:
  - Partial Status Epilepticus: A prolonged seizure involving one part of the brain.  
    * For example, a patient who has a tumor in his left frontal lobe who is awake and talking and interacting normally, but has persistent rhythmic jerking in his right hand, arm, and face. 
    * This form of SE needs emergency treatment but is not usually as life-threatening as other forms
  - Generalized Convulsive Status Epilepticus (GCSE): A prolonged seizure with coma and convulsive activity of all four extremities.
    * This is a life-threatening form of SE requiring urgent medical evaluation and treatment
    * GCSE can progress into Nonconvulsive Status Epilepticus (see below)
  - Nonconvulsive Status Epilepticus (NCSE):  Decreased responsive due to electrical seizure activity in the brain with subtle signs such as blinking or facial twitching or no overt signs
    * Although far less dramatic in its presentation than GCSE, NCSE is more dangerous and also requires prompt recognition and treatment
    * Continuous EEG recording is the only method to diagnosis NCSE
  - Myoclonic Status Epilepticus:  Coma and prolonged jerking of all four extremities
    * This form of SE is associated with the highest risk of death or severe disability (persistent vegetative state or coma)
    * Most commonly caused by profound lack of blood flow and oxygen to the brain due to dysfunction of the heart

• The prognosis of status epilepticus is directly related to two factors
  - The cause of the status.  For example, hypoxic-ischemic injury is associated with the worse outcome because the lack of blood flow has caused irreversible injuries to the brain
    * The duration of the status.  The sooner status is recognized and treated the better the outcome.

• Common causes for status epilepticus include:
  - Non-adherence: Persons with epilepsy who voluntarily or accidently stopped taking their seizure medication
  - Alcohol withdrawal
  - Brain infections like meningitis and encephalitis
  - Stroke
  - Traumatic Brain Injury