Status epilepticus
Resident Survival Guide |
For patient information, click here
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]
- Infections:
- CNS: Meningitis, encephalitis or brain abscess.
- Infections causing high fever especially in children.
Central nervous system (CNS) infections (meningitis, encephalitis and intracranial abscess) Metabolic abnormalities (hypoglycemia, hyponatremia, hypocalcemia, hepatic encephalopathy and inborn errors of metabolism in children) Cerebrovascular accidents Head trauma (with or without intracranial bleed) Drug toxicity Drug withdrawal syndromes (e.g., alcohol, benzodiazepines and barbiturates) Hypoxia Hypertensive emergency Autoimmune disorders
stroke hypoxia metabolic derangement toxicity (e.g. drugs) encephalitis alcohol intoxication or withdrawal pregnancy-related, e.g. eclampsia infections accompanied by fever (the most important cause in children) Radiographic features
Stroke[8] Hemorrhage[8] Intoxicants[8] or adverse reactions to drugs Insufficient dosage or sudden withdrawal of a medication (especially anticonvulsants) Consumption of alcoholic beverages while on an anticonvulsant, or alcohol withdrawal Dieting or fasting while on an anticonvulsant Starting on a new medication that reduces the effectiveness of the anticonvulsant or changes drug metabolism, decreasing its half-life, leading to decreased blood concentrations Developing a resistance to an anticonvulsant already being used Gastroenteritis while on an anticonvulsant, where lower levels of anticonvulsant may exist in the bloodstream due to vomiting of gastric contents or reduced absorption due to mucosal edema Developing a new, unrelated condition in which seizures are coincidentally also a symptom, but are not controlled by an anticonvulsant already used Metabolic disturbances—such as affected kidney and liver[8] Sleep deprivation of more than a short duration is often the cause of a (usually, but not always, temporary) loss of seizure control.
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 and delerium tremens.
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
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. [5]
- 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%.[6]
- Approximately 10 to 30% of patients with underlying brain condition who have status epilepticus die within 30 days.[7]
- 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]
Treatments
- ↑ "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 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.
- ↑ 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.
- ↑ 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.