Neuro Disorders: Status Epilepticus

Status Epilepticus (SE - unofficial abbreviation) is a real neurological and medical emergency, and presents as non stop or almost non stop seizures along with not regaining consciousness in between the seizures.

The precise duration required for the definition of SE may somewhat vary among authorities, however according to the recent definitions if the same seizure continues for more than about 5 minutes or so, or if the patient does not regain consciousness for more than 5 minutes between the seizures then it can be considered as SE.

The above term SE is generally used for grand mal seizures. But status can occur with any kind of seizures including petit mal, simple or complex partial seizures etc. Grand mal status is the most serious one, then comes the complex partial status.

Status is also divided as convulsive and non convulsive types.

EEG status is the term used when seizure activity in the EEG is seen continuously or almost continuously.

Abruptly stopping the anti seizure medications is one of the most common causes. However almost any condition that predispose somebody to get seizures can also predispose to SE as well; these conditions include, infections, fever, electrolyte abnormalities, sleep or food deprivations etc.

SE diagnosis is clinical one.

Depending upon the circumstance a head CT or MRI, several blood tests, EEG, spinal fluid analysis may be necessary.

Treatment should be initiated rapidly because any time delay will increase the risk of permanent brain injury as well as death. The following approach is adopted;

• Stabilize blood pressure, breathing & heart rate
• IV (Intravenous) glucose injection - if hypoglycemia is present or suspected
• IV Thiamine - (if alcohol history is there)
• IV Lorazepam or Diazepam
• If no help with above measures then IV Phenytoin
• If seizures continue IV Phenobarbitone
• If Seizures continue then Pentobarbitone Coma (or other similar agents)

A neurologist is frequently involved in the care of patients with SE.