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Status epilepticus (SE) is a medical emergency requiring immediate, targeted treatment
to help reduce patient morbidity and mortality. SE can be convulsive or non-convulsive,
with convulsive status epilepticus (CSE) being the most common neurologic medical
emergency in childhood. Prognosis is dependent on management of the underlying
condition and on prompt treatment of seizures.
Definition:
The Neurocritical Care Society (Brophy et al 2012) recently defined status epilepticus
as: "5 minutes or more of (i) continuous clinical and/or electrographic seizure activity or
(ii) recurrent seizure activity without recovery (returning to baseline) between seizures."
This is a shorter seizure duration than the previously accepted definition of 30 minutes or
longer of continuous seizure activity. The definition was revised since most clinical and
electrographic seizures last less than 5 min, and seizures that last longer often to do not
stop spontaneously. Animal data also suggest that prolonged seizures are more
pharmacoresistant, may cause permanent neuronal injury and are associated with worse
cognitive and behavioral outcomes.
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Status Epilepticus Pathway
Selected References:
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Abend NS, Dlugos DJ. Treatment of refractory status epilepticus: literature review and a
proposed protocol. Pediatr Neurol. 2008 Jun;38(6):377-90
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Abend NS, Loddenkemper T. Management of pediatric status epilepticus. Curr Treat
Options Neurol. 2014 Jul;16(7):301
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Brophy GM, Bell R, Claassen J, Alldredge B, Bleck TP, Glauser T, Laroche SM, Riviello
JJ Jr, Shutter L, Sperling MR, Treiman DM, Vespa PM; Neurocritical Care Society Status
Epilepticus Guideline Writing Committee. Guidelines for the evaluation and
management of status epilepticus. Neurocrit Care. 2012 Aug;17(1):3-23
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Jenssen S, Gracely EJ, Sperling MR. How long do most seizures last? A systematic
comparison of seizures recorded in the epilepsy monitoring unit. Epilepsia. 2006 Sep;
47(9):1499-503
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Mazarati AM. Time-dependent decrease in the effectiveness of antiepileptic drugs during
the course of self-sustaining status epilepticus. Brain Res. 1998;814(1–2):179
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Miquel Raspall-Chaure, Richard FM Chin, Brian G Neville, Rod C Scott. Outcome of
paediatric convulsive status epilepticus: a systematic review. Lancet Neurol. 2006 Sep;
5(9):769-79
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Scott, RC. Adverse outcomes following convulsive status epilepticus in children:
Relationship with hippocampal injury. Epilepsia. 2010 Jul;51 Suppl 3:178-81
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Shinnar S, Berg AT, Moshe SL, Shinnar R. How long do new-onset seizures in children
last? Ann Neurol. 2001 May;49(5):659-64
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Status Epilepticus Pathway