Status epilepticus (SE) is a term describing continuous abnormal electrical activity of the brain. In other words, SE is a perpetual seizure.
Seizures are due to abnormal electrical discharges in the brain. This electrical activity may be localized to an area of damaged brain and/or spread to involve the entire brain. Alternately, seizure may begin diffusely involving the entire brain usually due to an infection or metabolic problem such as alcohol withdrawal.
SE occurs when a seizure continues unceasingly. During this time, the person never regains consciousness. This type of prolonged seizure is a medical emergency and can result in permanent brain injury or death if it is not treated immediately.
SE can be convulsive or nonconvulsive. A person's symptoms can range from simply appearing dazed (nonconvulsive) to a dramatic display of involuntary muscle contractions, jerks, spasms, and loss of consciousness (convulsive). The specific symptoms depend on the underlying type of seizure. Convulsive SE is the more serious type, and the one associated with a worse prognosis if treatment is delayed.
The most common cause of SE is noncompliance with a seizure medication regimen by an individual with a known seizure disorder. However, any condition that increases the risk of seizure can lead to SE. These include: stroke brain tumor intracerebral hemorrhage, that is, bleeding in the braintrauma or head injury hypoxia, that is, not enough oxygen getting to the braincocaine usealcohol withdrawal certain medications such as theophyllinesalt or blood glucose imbalances serious infections that affect the brain, such as encephalitis
A person who is taking medications to prevent seizures should take them as prescribed. If the level of medication in the bloodstream falls too low, SE may occur.
The diagnosis is based on the history and physical examination. Nonconvulsive SE can be more difficult to diagnose than convulsive SE. A variety of laboratory and other special tests aid in the diagnosis. Emergency treatment will continue while these tests are being done: blood tests and drug screening tests to detect drug toxicity or withdrawalarterial blood gases to help determine acid-base imbalances and monitor the level of oxygen in the bloodcranial CT scan or cranial MRI to detect brain tumors or bleedingelectroencephalogram (EEG), to measure changes in the electrical activity in the brain
Status epilepticus can lead to permanent brain damage and death.
There are no risks to others.
Time is the critical issue. A person will be given emergency care while the cause of the seizure is being determined. Emergency care includes: giving oxygen starting an intravenous line to inject medicationsgiving anti-seizure medication keeping the person from injury
Intubation, ventilation, and inducing coma may be required to stop the seizure in some cases.
Side effects of treatment depend on the medications given. Anti-seizure medication may cause drowsiness in some people and hyperactivity in others. Intubation and ventilation have risks including but not limited to dental trauma and pneumonia respectively.
After emergency treatment, a person will need to take any daily seizure medications exactly as prescribed.
A person may need follow-up visits to the healthcare professional for clinical assessment, and to make sure that the level of medication in the bloodstream is appropriate. The dose may need to be adjusted. The person may need to wear a MedicAlert bracelet if epilepsy is diagnosed.
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The Merck Manual, 1999
Harrison's Principles of Internal Medicine, 1991
