An Overview of Status Epilepticus

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Status epilepticus is a dangerous situation in which a seizure or a cluster of seizures last for longer than 5 minutes without improvement in consciousness.

When seizures do not improve on their own or with medication, brain damage or death can occur. Status epilepticus is a medical emergency requiring an injection of anti-seizure medication. Sometimes, a person with status epilepticus may not improve, even with medication, and continues to experience seizures even with treatment.

Symptoms

In general, seizures tend to last for a few seconds. However, prolonged seizures, with or without treatment, are unusual and are more likely to occur in people who have substantial brain damage.

The symptoms of status epilepticus may be easily recognizable in some situations, but that is not always the case. Sometimes, status epilepticus can be subtle, especially in people who are severely ill.

That is because there are many types of seizures, and some are convulsive, characterized by shaking or jerking of the body, while some are non-convulsive, and produce impairment of consciousness without shaking of the body. Young babies or children with developmental problems may have seizures characterized by loss of muscle tone, which may go unnoticed. And individuals who are extremely sick and who already have a low degree of alertness may also experience seizures that are not obvious.

Status epilepticus may produce:

  • 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
  • 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
  • Repetitive facial movements, sounds, or gestures, generally with a lack of awareness

Causes

There are some triggers and conditions that can make status epilepticus more likely, but sometimes it can occur without a known reason.

  • 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 but 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 which may trigger seizures. If the condition is not corrected promptly, the seizure can be prolonged, resulting in 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.

Diagnosis

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

Convulsive status epilepticus can be recognized by the shaking and jerking of the body. Typically, a person experiencing nonconvulsive status epilepticus can appear unresponsive or confused. This makes it difficult to distinguish from other conditions, such as delirium, a state of confusion, which can be caused by infections, medications, or illness. Similarly, encephalopathy, characterized by impairment of brain function, often results from liver failure or kidney failure. Sometimes, status epilepticus can manifest with sudden weakness of one side of the body, which can be easily mistaken for stroke.

  • 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 is not treated with the same medications as the other conditions that produce 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 anti-anticonvulsant that can be injected or which can be placed in the rectum, which is an easier route of adminstartation for young babies. The American Epilepsy Society has made recommendations for the treatment of status epilepticus.

Medications used for status epilepticus include:

  • Intravenous (IV) lorazepam
  • IV diazepam
  • Rectal diazepam
  • IM midazolam
  • Intranasal midazolam
  • Buccal midazolam
  • IV valproic acid or IV phenobarbital as second therapy after failure of a benzodiazepine.

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 cause encephalopathy to worsen.

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 have a tendency to have recurrent status epilepticus, it is important to try to learn how to recognize the symptoms that occur right before the seizure and to take medication right away to try to avert the seizure from happening. It may also be useful to have a convenient method of calling for emergency medical help so that you can receive proper treatment when necessary.

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

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Article Sources
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  • Lu WY, Weng WC, Wong LC, Lee WT. The etiology and prognosis of super-refractory convulsive status epilepticus in children. Epilepsy Behav. 2018 Jul 10. pii: S1525-5050(18)30390-1. doi: 10.1016/j.yebeh.2018.06.029. [Epub ahead of print]