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Status Epilepticus - Management and Causes

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Updated April 16, 2014

Status epilepticus, or very long lasting seizures, is a medical emergency that requires quick attention - in fact, quick medical care can save a life.

A seizure is abnormal, disorganized electrical activity that occurs within the brain. If someone has recurrent seizures, a diagnosis of epilepsy is made based on blood studies, a comprehensive medical history, and other tests, such as an EEG, spinal tap, or imaging studies. It is at this point that your healthcare provider will prescribe you the proper medications that will control your condition.

With epilepsy, you will find that most seizures may last up to a few minutes. In some rare instances, they may last longer and may, in fact, appear not to stop at all. This is referred to as status epilepticus. It is estimated that about 50,000 to 60,000 individuals in the United States are affected by status epilepticus every year.

What Is Status Epilepticus?

During status epilepticus, a person with epilepsy will have impaired consciousness and persistent or repetitive seizures. Normal seizures will last only a few minutes. However, when a seizure lasts 15 to 30 minutes without consciousness being regained, the individual will be diagnosed with status epilepticus.

Status epilepticus is a medical emergency that requires quick and careful medical treatment and could be deadly if not immediately addressed. Complications that could arise from status epilepticus include dysfunction of the heart or lungs, metabolic changes, an increase in body temperature, and ultimately, irreversible brain injury.

Status epilepticus can be classified as convulsive or nonconvulsive. Convulsive means a person is having an obvious convulsive episode. Nonconvulsive refers to a state of confusion and impaired consciousness. Individuals in a nonconvulsive state will not appear to be having an obvious seizure, but they still have the electrical misfirings in the brain that are consistent with a seizure. After a convulsive seizure has stopped and the person has not regained consciousness after a period of time, a healthcare provider will consider performing an EEG to make sure the person is not in nonconvulsive status.

What Causes Status Epilepticus?

Status epilepticus is a critical and life-threatening condition that requires rapid and urgent medical treatment in order to prevent further complications and to preserve the brain function. Status epilepticus can affect any age group. Additionally, certain factors can cause status epilepticus depending on the person’s age. These precipitating factors include:
  • systemic infections (infections affecting large portions of the body)
  • febrile (fever-related) disease
  • head trauma
  • stroke
  • certain cancers
  • abrupt withdrawal of anticonvulsant medications
  • abrupt withdrawal of alcohol or illicit drugs
  • metabolic disorders (low sodium, low calcium low or high blood sugar)
  • low concentration of antiepileptic drug in blood
  • How Is Status Epilepticus Treated and Prevented?

    Status epilepticus can be deadly and should not be taken lightly. One study noted that the death rate for the population diagnosed with epilepsy was as high as 22%, with a mortality rate of 3% in children and 26% in adults. Therefore, quick action is very important.

    The initial treatment begins with the ABC rules: Make sure the individual’s airway is clear, the individual is breathing and to restore the body fluid. A medical assessment will also be performed to find out why the individual went into status epilepticus in the first place. In order to control the seizures, certain medications will be used. The most common and preferred medications used are benzodiazepines, which include diazepam, lorazepam, and midazolam. Lorazepam is often used due to its fast action. In the event that the individual is not responding to lorazepam, other antiepileptic drugs, such as phenytoin, phenobarbital and fosphenytoin can be used.

    In order to prevent status epilepticus, individuals should be compliant with their antiepileptic medications. Additionally, regular visits to their healthcare provider should be made to ensure that the medication is working properly, no other medications have been added that could reduce the effectiveness of their antiepileptic medications, and to assess for any other conditions (such as alcoholism, uncontrolled diabetes, metabolic disturbances) that could interrupt seizure control.

    Sources:

    Feen ES, Bershad EM, Suarez JI. Status epilepticus. South Med J. 2008 Apr;101(4):400-6.

    Garcia JJ, Molins A, Puig JS. Status epilepticus: evidence and controversy. The Neurologist 2007; 13:S62-S73.

    DeLorenzo RJ, Hauser WA, Towne AR, et al. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology. 1996 Apr;46(4):1029-35.

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