Status epilepticus
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]
Synonyms and keywords:
Overview
Historical Perspective
- Status epilepticus was included in the classification of seizures of the International League Against Epilepsy of 1970 and 1981.[1]
Classification
- There is no established system for the classification of status epilepticus.
- However, status epilepticus can be divided into:
- Generalized Convulsive Status Epilepticus(GCSE), seizures last more that five minutes with tonic-clonic movement.
- Non-convulsive Status Epilepticus can be identified on electroencephalogram(EEG) with no motor convulsive activity (e.g persistent absence seizure)
- Focal seizure affecting a group of muscle with/without loss of consciousness.
- Myoclonic status epilepticus with prolonged jerks and epileptiform discharges on EEG.
- Refractory status epilepticus, continuous seizure not responding to treatment.[2] [3]
Pathophysiology
Causes
- Following are the conditions that could lead to a status epilepticus:
- Epilepsy: Approximately twenty-five percent of patients with status epilepticus have epilepsy.[4]
- Stroke[4]
- Infections: CNS infections such as meningitis, encephalitis or brain abscess. Other infections that cause fever, especially in children.
- Metabolic abnormalities: This could be a result of underlying renal or hepatic pathology causing hyponatremia, hypoglycemia or hypocalcemia.
- Cerebral trauma or cerebrovascular accidents due to hypertensive crisis.[5]
- Alteration in anticonvulsive therapy including but not limited to sudden withdrawal or sub-optimal dosing, concomitant alcohol consumption, inadequate nutrition, starting a new medication that is non-compatible with anticonvulsive drugs and/or drug resistance.
- Hypoxia[5]
- Drug toxicity[5]
- Eclampsia
Differentiating Status epilepticus from other Diseases
- Status epilepticus must be differentiated from other disorders that may mimic the clinic presentation such as neuroleptic malignant syndrome, psychogenic nonepileptic seizures, delerium tremens, low blood sugar, and movement disorders. [6]
Epidemiology and Demographics
- The incidence of status epilepticus is approximately 7 to 40 cases per 100,000/year.
- Status epilepticus seems to be more common in male.
Risk Factors
Screening
- There is insufficient evidence to recommend routine screening for status epilepticus.
Natural History, Complications, and Prognosis
- Common complications of status epilepticus include cardiac dysrhythmia, metabolic derangements, autonomic dysfunction, neurogenic pulmonary edema, hyperthermia, rhabdomyolysis, and aspiration pneumonia. [7]
- Permanent neurologic damage can occur with prolonged status epilepticus.
- Prognosis of status epilepticus depends upon the underlying cause, age, and medical condition of the patient. Overall mortality rate of status epilepticus is 7%–39%.[8]
- Approximately 10 to 30% of patients with underlying brain condition who have status epilepticus die within 30 days.[6]
- Patients with epilepsy and who develop status epilepticus have increased mortality risk. However, stabilizing condition and optimal maintenance of medication, sleep, stress factors and stimulants plays an important role in improving prognosis. [4]
Diagnosis
Diagnostic Study of Choice
- History
History and Symptoms
- Patient may have a recent history of infection with fever, head trauma, alteration in medication, sleep deprivation, alcohol use/withdrawal.
- Past medical history of the patient could include stroke, prior seizures, meningitis, encephalitis.
Physical Examination
Laboratory Findings
- There are no diagnostic laboratory findings associated with status epilepticus.
- However, electrolyte, BUN, creatinine, glucose, LFT, toxicology and medication level should be checked to indentify the underlying cause.
Electrocardiogram
- There are no ECG findings associated with status epilepticus.
X-ray
- There are no x-ray findings associated with status epilepticus.
Echocardiography or Ultrasound
- There are no echocardiography/ultrasound findings associated with status epilepticus.
CT scan
- There are no CT scan findings associated with status epilepticus.
- In patients with a previous history of stroke may appear on CT scan.
MRI
Other Imaging Findings
- There are no other imaging findings associated with status epilepticus.
Other Diagnostic Studies
- Electroencephalogram (EEG) is
Treatments
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
References
- ↑ "A Proposed International Classification of Epileptic Seizures". Epilepsia. 5 (4): 297–306. 1964. doi:10.1111/j.1528-1157.1964.tb03337.x. ISSN 0013-9580.
- ↑ Won, Sae‐Yeon; Dubinski, Daniel; Sautter, Lisa; Hattingen, Elke; Seifert, Volker; Rosenow, Felix; Freiman, Thomas; Strzelczyk, Adam; Konczalla, Juergen (2019). "Seizure and status epilepticus in chronic subdural hematoma". Acta Neurologica Scandinavica. 140 (3): 194–203. doi:10.1111/ane.13131. ISSN 0001-6314.
- ↑ Harrison's Manual of Medicine 19th Edition
- ↑ 4.0 4.1 4.2 Stasiukynienė, Virginija; Pilvinis, Vidas; Reingardienė, Dagmara; Janauskaitė, Liuda (2009). "Epileptic seizures in critically ill patients". Medicina. 45 (6): 501. doi:10.3390/medicina45060066. ISSN 1010-660X.
- ↑ 5.0 5.1 5.2 Langenbruch, Lisa; Krämer, Julia; Güler, Sati; Möddel, Gabriel; Geßner, Sophia; Melzer, Nico; Elger, Christian E.; Wiendl, Heinz; Budde, Thomas; Meuth, Sven G.; Kovac, Stjepana (2019). "Seizures and epilepsy in multiple sclerosis: epidemiology and prognosis in a large tertiary referral center". Journal of Neurology. 266 (7): 1789–1795. doi:10.1007/s00415-019-09332-x. ISSN 0340-5354.
- ↑ 6.0 6.1 Al-Mufti, Fawaz; Claassen, Jan (2014). "Neurocritical Care". Critical Care Clinics. 30 (4): 751–764. doi:10.1016/j.ccc.2014.06.006. ISSN 0749-0704.
- ↑ Sutter, Raoul; Dittrich, Tolga; Semmlack, Saskia; Rüegg, Stephan; Marsch, Stephan; Kaplan, Peter W. (2018). "Acute Systemic Complications of Convulsive Status Epilepticus—A Systematic Review". Critical Care Medicine. 46 (1): 138–145. doi:10.1097/CCM.0000000000002843. ISSN 0090-3493.
- ↑ Towne, Alan R.; Pellock, John M.; Ko, Daijin; DeLorenzo, Robert J. (1994). "Determinants of Mortality in Status Epilepticus". Epilepsia. 35 (1): 27–34. doi:10.1111/j.1528-1157.1994.tb02908.x. ISSN 0013-9580.