Status

Epilepticus
 Table of contents
01. 02. 03.
Clinical
Pathophysiology Classification
Manifestation

04. 05. 06.

Diagnosis Treatment Medication
 Introduction
Status epilepticus (SE) is a life-threatening medical
emergency that occurs when a person has a continuous
seizure or multiple seizures without enough time to
recover between them. It is defined as continuous
seizure activity for 5 minutes or more without return
of consciousness, or recurrent seizures (2 or more)
without an intervening period of neurological
recovery. While it’s more likely to happen to people
with epilepsy, many conditions can cause continuous
or repeated seizures in people who don’t have
epilepsy.
 01.
Pathophysiology
This medical emergency can happen to people with epilepsy, but many other conditions
can also cause continuous or repeated seizures.

In simple terms, think of the brain as a city with lots of roads (neurons). Normally,
traffic (electrical activity) flows smoothly. But during a seizure, there’s a traffic jam -
the electrical signals in the brain become scrambled and there are sudden bursts of
electrical activity.

Now, imagine if this traffic jam doesn’t clear up, or if multiple jams happen one after
the other without enough time for the roads to clear up. This is what happens during
status epilepticus. The neurons can’t handle extended periods of uncontrolled activity.
Just as too much electrical current can overload and damage an electronic device,
uncontrolled seizure activity during SE can damage your neurons. This kind of damage
is often permanent, which means you might lose abilities that affected areas of your
brain once controlled.
 02.
Classification
Classified into several types based on their clinical features:
Includes generalized tonic-clonic
01. Generalized Status Epilepticus SE, clonic SE, absence SE, tonic
SE, and myoclonic SE.

Includes epilepsia partialis

continua, aura continua, limbic SE
02. Focal Status Epilepticus (psychomotor
hemiconvulsive
status),
SE
and
with
hemiparesis

This is a type of SE where the

Nonconvulsive Status person may appear to be in a state
03. Epilepticus
of confusion or unresponsiveness,
but there are no visible
convulsions.

04. Convulsive Status Epilepticus This is a type of SE where the

person has visible convulsions.
 03.
Clinical Manifestation
The clinical manifestations of Status Epilepticus (SE) can vary widely, but here
are some common symptoms:

Seizures: The most obvious symptom of SE is a seizure that lasts much longer
than usual, or seizures that occur in quick succession with no time between the
seizures for the person to recover.

Confusion or Unresponsiveness: During a nonconvulsive SE, the person may

appear to be in a state of confusion or unresponsiveness, but there are no visible
convulsions.

Convulsions/Spasms: During a convulsive SE, the person has visible

convulsions. These can include uncontrollable jerking movements of the arms and
legs.
Temporary Confusion: A person may experience temporary confusion during a
seizure.

Staring Spell: Some people stare blankly for a few seconds during a seizure.

Stiff Muscles: Muscles may become stiff during a seizure.

Loss of Consciousness or Awareness: A person may lose consciousness or

awareness during a seizure.

Psychological Symptoms: Some people may experience psychological symptoms

such as fear, anxiety, or deja vu during a seizure.
 04.
Diagnosis
The diagnosis of Status Epilepticus (SE) involves several steps:

Clinical Assessment: The first step in diagnosing SE is a clinical assessment. This

involves observing the patient’s symptoms and taking a detailed medical history. The
key diagnostic factors include persistent or repetitive tonic-clonic seizures with altered
level of consciousness (generalized convulsive SE) and altered awareness/confusion
(nonconvulsive SE).

Diagnostic Criteria: Diagnostic criteria vary, but most practitioners diagnose as status
epilepticus for one continuous, unremitting seizure lasting longer than five minutes, or
recurrent seizures without regaining consciousness between seizures for greater than
five minutes.
Laboratory Tests: Doctors may order several laboratory tests to help diagnose SE.
These can include glucose and electrolyte levels tests, a complete blood count, renal
and liver function tests, and toxicological screening.

Imaging Tests: Imaging tests such as CT or MRI scans of the brain may be performed
to look for any structural abnormalities that could be causing the seizures.

Electroencephalography (EEG): An EEG, which records the electrical activity of the

brain, is often used to confirm the diagnosis of SE. It can help determine the type of
seizures and whether they are focal (occurring in one part of the brain) or generalized
(occurring throughout the brain).
 05.
Treatment
 Treatment
01.
Self-care Treatment
• Protect the person’s head while they are
having a seizure.
• Move the person to a safe place away from
danger.
• Giving emergency medical care.
 Treatment
02.
Medical Treatment
• Provision of emergency medication.
• Oxygen and other fluids.
• Breathing support.
• At times, the person may be put into an
induced coma, through the use of
anesthetics, to stop the seizure
 Treatment
03.
Specalists Treatment
• Neurologist: Specializes in treating diseases of the
nervous system, which includes the brain, the spinal
cord, and the nerves.

• Emergency medicine specialist: Specializes in

identifying and managing illnesses or injuries requiring
immediate medical attention.
 06.
Medication
The following medications are used in the treatment of Status Epilepticus:

Lorazepam (Ativan, Ativan Inj, Intensol, Loreev XR): This is a

benzodiazepine, miscellaneous antiemetic, and benzodiazepine anticonvulsant.

Diazepam (Valium): This is a benzodiazepine and benzodiazepine anticonvulsant.

Phenytoin (Dilantin): This is a hydantoin anticonvulsant and group I

antiarrhythmic.

Midazolam (Dormizol):This is another medication used to treat Status Epilepticus.

Levetiracetam (Keppra) and Fosphenytoin (Cerebyx): are also used to treat status
epilepticus.
 Conclusion
Status epilepticus is a critical neurological condition characterized by
continuous or recurrent seizures without any recovery period in between. It is a
medical emergency that requires immediate attention and intervention. The
primary goal of treatment is to control the seizures as quickly as possible to
prevent further neurological damage and systemic complications. Medications
such as Lorazepam, Diazepam, Phenytoin, Midazolam, Levetiracetam, and
Fosphenytoin are commonly used in the management of this condition.
However, the choice of medication and the course of treatment should always
be individualized based on the patient’s specific circumstances and under the
guidance of a healthcare professional. Despite advances in treatment, status
epilepticus remains a life-threatening condition with significant morbidity and
mortality, underscoring the need for prompt recognition and aggressive
management.
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