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Status Epilepticus

Definition

Status epilepticus (SE) is a term describing continuous abnormal electrical activity of the brain. In other words, SE is a perpetual seizure.

What is going on in the body?

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.

Risks

What are the causes and risks of the condition?

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 brain
  • trauma or head injury
  • hypoxia, that is, not enough oxygen getting to the brain
  • cocaine use
  • alcohol withdrawal
  • certain medications such as theophylline
  • salt or blood glucose imbalances
  • serious infections that affect the brain, such as encephalitis

Prevention

What can be done to prevent the condition?

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.

Diagnosed

How is the condition diagnosed?

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 withdrawal
  • arterial blood gases to help determine acid-base imbalances and monitor the level of oxygen in the blood
  • cranial CT scan or cranial MRI to detect brain tumors or bleeding
  • electroencephalogram (EEG), to measure changes in the electrical activity in the brain

Long Term Effects

What are the long-term effects of the condition?

Status epilepticus can lead to permanent brain damage and death.

Other Risks

What are the risks to others?

There are no risks to others.

Treatments

What are the treatments for the condition?

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 medications
  • giving 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

What are the side effects of the treatments?

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 Treatment

What happens after treatment for the condition?

After emergency treatment, a person will need to take any daily seizure medications exactly as prescribed.

Monitor

How is the condition monitored?

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.

Sources

[hyperLink url="http://www.aafp.org/" linkTitle="www.aafp.org"]www.aafp.org[/hyperLink]

The Merck Manual, 1999

Harrison's Principles of Internal Medicine, 1991

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