Overview of Status Epilepticus

A potentially deadly complication of epilepsy

In This Article

Table of Contents
Doctor holding oxygen mask over male patients mouth in intensive care unit
Caiaimage/OJO+/Getty Images

Status epilepticus is a dangerous situation in which a seizure or a cluster of seizures last for longer than five minutes without improvement in consciousness.

When seizures do not improve, on their own or with medication, they can cause brain damage or even death. Status epilepticus is a medical emergency requiring an injection of anti-seizure medication.

Sometimes, a person with status epilepticus may not improve despite treatment.

Symptoms

In general, seizures tend to last for a few seconds. Some forms may last for a minute or two. However, prolonged seizures are rare—and always an emergency.

The symptoms of status epilepticus may be easy to recognize in some situations, but other times it's more difficult. Some cases of status epilepticus can be subtle, especially in people who are severely ill.

That is because there are many types of seizures. The convulsive ones, which are characterized by shaking or jerking, are usually obvious. Some are non-convulsive, though, and impair the person's consciousness without any shaking or obvious physical symptoms.

Young babies or children with developmental problems may have seizures characterized by loss of muscle tone, which may go unnoticed. Additionally, people who are extremely sick and who already have a low degree of alertness may also experience seizures that are not obvious.

Symptoms of status epilepticus are generally the same as those for epilepsy, only lasting longer than five minutes, or happening repeatedly without the person regaining consciousness.

Symptoms of Status Epilepticus

  • Persistent shaking or jerking of the body lasting for longer than 5 minutes
  • Falling to the ground and remaining unresponsive
  • Lack of alertness for longer than 5 minutes
  • Prolonged staring spells
  • A complete lack of physical activity for longer than 5 minutes
  • Decreased muscle tone for longer than 5 minutes
  • Weakness on one side of the body, involving the face arm, or leg, lasting more than 5 minutes
  • Repetitive facial movements, sounds, or gestures, generally with a lack of awareness, that last longer than 5 minutes

Get emergency medical help when:

  • Seizure symptoms last for longer than five minutes
  • Someone loses consciousness and doesn't wake up
  • Someone has repeated seizures without waking up in between

Causes

Some triggers and conditions make status epilepticus more likely, but sometimes it can occur without a known reason.

Possible triggers include:

  • Epilepsy syndromes: People who suffer from severe seizure disorders, such as Rasmussen's syndrome, Rett syndrome, Lennox Gastaut syndrome, and Dravet syndrome are more prone to status epilepticus. Episodes are more likely to occur during illness, infection, or when medications are skipped. They can occur without a trigger.
  • Cerebral damage: People who have had extensive damage to the cerebral cortex, the region of the brain most likely to produce seizures, are more likely to experience status epilepticus than people who have small areas of limited brain damage. Hypoxia (low oxygen) prior to birth, cerebral palsy, head trauma, and severe blood loss can cause substantial cerebral damage which can raise the likelihood of status epilepticus, even years after the condition is resolved.
  • Brain tumor: Tumors and cancer in the brain can produce seizures, and may cause status epilepticus, particularly if they are large or if there are several tumors.
  • Electrolyte abnormalities: Blood loss, dehydration, malnutrition, drug overdose. and medications can all cause electrolyte imbalances that may trigger seizures and status epilepticus.
  • Drug or alcohol overdose or withdrawal: Alcohol and drugs such as cocaine, methamphetamine, and heroin can produce brief seizures or status epilepticus. Drug or alcohol withdrawal after heavy use or prolonged use and be just as dangerous, causing seizures during the withdrawal period and up to several days afterward.
  • Encephalitis: An infection of the brain, while not common, can cause severe, prolonged status epilepticus.

Status epilepticus is extremely rare, occurring in between 50,000 and 150,000 people in the U.S. each year. It's more likely in children under 10, adults over 50, and those with febrile (fever-related) seizures.

In studies, between 30 and 44 percent of cases are in people previously diagnosed with epilepsy. In children, nearly 70 percent of cases are in those with diagnosed epilepsy, and skipping medication was believed to be a major cause.

In the U.S., studies show that black people are significantly more likely than those of other races to experience status epilepticus. Researchers suspect this is due, at least in part, to socioeconomic factors that may influence the ability to access treatment.

Death from status epilepticus is more common in men than in women, and it grows more common with age. Children under 10 have the best outcomes, with deaths in less than 3 percent of cases. That goes up to 30 percent for adults.

Diagnosis

Status epilepticus can be diagnosed by clinical observation, but most often an electroencephalogram (EEG), brain imaging, or lumbar puncture is needed to verify the diagnosis.

  • EEG: Because the clinical symptoms of status epilepticus and several other conditions may be similar, an EGG is usually needed to distinguish between seizures and patterns that are consistent with conditions such as stroke and encephalopathy.
  • Brain imaging: A brain CT or MRI scan may be needed to determine the cause of the seizures and to identify conditions such as a stroke, brain tumor, or inflammation in the brain.
  • Lumbar puncture: If there is a possible infection, it can be diagnosed using a lumbar puncture, which is a procedure that examines the fluid that surrounds the brain and spinal cord.

Diagnosing status epilepticus and identifying the cause is important because status epilepticus requires different treatment than the other conditions with similar symptoms.

Treatment

Status epilepticus is a medical emergency. It can cause death due to physical injury, choking, or as a result of the seizure itself. The episode may cause lasting brain damage, which can result in worsening seizures, increased predisposition to status epilepticus, and cognitive decline.

If you or your child is prone to this condition, your doctor will give you a prescription for an injectable anti-convulsant. For a baby, you may be given a form that's put in the rectum, which can be an easier method. The American Epilepsy Society has made recommendations for the treatment of status epilepticus.

First-line medications for status epilepticus include:

  • IM (intramuscular) midazolam
  • Intravenous (IV) lorazepam
  • IV diazepam
  • Rectal diazepam
  • Intranasal midazolam
  • Buccal midazolam

If the initial drug doesn't work, emergency medical staff may use a second drug, including:

  • IV valproic acid
  • IV fosphenytoin
  • IV levetiracetam
  • IV phenobarbital

These medications are fast acting, and their effects do not typically last for longer than a few hours. They can cause worsening symptoms for people who do not have epilepsy. For example, lorazepam can make encephalopathy worse.

When status epilepticus is triggered by medical problems, it is important to treat these conditions once the seizures are controlled.

Treatment approaches may include:

  • Treatment of infections
  • Correcting electrolyte and metabolic problems
  • Steroid treatment to reduce swelling caused by tumors
  • Surgery to remove a tumor

A Word From Verywell

If you or your child has experienced status epilepticus, it can be a frightening experience.

If you've had status epilepticus multiple times, it is important to recognize the symptoms that occur right before the seizure and to take medication to try to prevent it. Have a convenient method of calling for emergency medical help so that you can receive proper treatment as soon as possible.

With the right treatment, seizures can be controlled, the episodes of status epilepticus can be reduced, and the triggering cause(s) can be treated.

Was this page helpful?
Article Sources