The 2 types of status epilepticus presents with different signs and symptoms. These include:

• Convulsive status epilepticus is characterized by pattern of contractions accompanied by extraction of arms and the legs. In addition, myoclonus is also evident in comatose patients.
• Non-convulsive status epilepticus, causes change in the level of consciousness of the affected individual for a longer duration. Such a type of status epilepticus is characterized by 2 states: development of partial seizures or complex partial seizures. Affected individuals suffer from episodes of prolonged duration stupor, periods of unresponsiveness and staring [8].
• In addition, affected individuals would also experience difficulty in speaking, exhibit an unusual behavior pattern, irregular breathing, clenching of teeth, loss of control over bowel habits, development of muscle spasms and confusion.

• Epilepsy

  This may rarely lead to refractory epilepsy and hippocampal sclerosis (HS). We report the first case of epilepsy surgery in a liver-transplanted patient with refractory temporal lobe epilepsy. [ncbi.nlm.nih.gov]

• Fever

  INTERPRETATION: Acute encephalopathy after status epilepticus is more prone to occur in patients with Dravet syndrome who had a high fever. The mortality rate is high in severe cases. [ncbi.nlm.nih.gov]

  B349, viral infection, would include the fever and vomiting and are therefore not coded separately. [3mhisinsideangle.com]

• High Fever

  INTERPRETATION: Acute encephalopathy after status epilepticus is more prone to occur in patients with Dravet syndrome who had a high fever. The mortality rate is high in severe cases. [ncbi.nlm.nih.gov]

  Most cases of SE happen to children under age 15 who have seizures brought on by high fever, and adults over 40 (most often because of strokes). [webmd.com]

  Causes may include AED therapy noncompliance, acute infections or high fever. [texaschildrens.org]

• Noncompliance

  AEM) with which to load patients, as it is no longer a first-line AEM, and argues in favor of using a first-line AEM such as valproate or carbamazepine, or preferably the AEM that previously proved efficacious in a patient with known epilepsy who was noncompliant [ncbi.nlm.nih.gov]

  Principal causes of GCSE are antiepileptic drug withdrawal or noncompliance, metabolic disturbances, drug toxicity, CNS infections, CNS tumors, refractory epilepsy, and head trauma. [accessmedicine.mhmedical.com]

  The most common causes of status epilepticus are noncompliance or discontinuation of antiepileptic medications. However, alcohol and drug toxicity or withdrawal, CNS infections, CNS malignancies and severe head trauma must all be ruled out. [youtube.com]

  Causes may include AED therapy noncompliance, acute infections or high fever. [texaschildrens.org]

• Unconscious State

  Because of the emergency nature of status epilepticus and the unconscious state of the patient, enrollment took place under a waiver of informed consent pursuant to federal regulations. [nejm.org]

• Tachypnea

  Patients in alcohol will have abnormal vital signs including tachycardia, hypertension, hyperthermia and tachypnea. This is predominantly a clinical diagnosis. [saem.org]

  One of the circulatory consequences of status asthmaticus apart from tachycardia and tachypnea is also a large respiratory phase variation in pleural pressure. [ncbi.nlm.nih.gov]

• Fecal Incontinence

  In cases where the event was not witnessed, physical exam findings such a bite marks on the tongue or lips, or urinary or fecal incontinence may suggest a recent seizure. [saem.org]

• Tachycardia

  PATIENT PRESENTATION: We describe a 5-month-old girl with Dravet syndrome who presented with paroxysmal supraventricular tachycardia during status epilepticus. [ncbi.nlm.nih.gov]

  Patients in alcohol will have abnormal vital signs including tachycardia, hypertension, hyperthermia and tachypnea. This is predominantly a clinical diagnosis. [saem.org]

  GCSE is obvious when overt convulsions are present, but after 30–45 min of uninterrupted seizures, the signs may become increasingly subtle (mild clonic movements of the fingers; fine, rapid movements of the eyes; or paroxysmal episodes of tachycardia [accessmedicine.mhmedical.com]

• Muscle Twitch

  twitches or tonic eye deviation). [nejm.org]

  EPC is characterized by “spontaneous regular or irregular clonic muscle twitching of cerebral cortical origin, sometime aggravated by action or sensory stimuli, confined to one part of the body, and continuing for a period hours days, or weeks” (Obeso [onlinelibrary.wiley.com]

  In the intervals between clonic muscle twitches, its hypotension is observed. If the attack lasts a couple of minutes, then consciousness is quickly restored. [bad-skin.ru]

• Seizure

  Status epilepticus is a condition characterized by occurrence of seizures for a period of more than 30 minutes, or several seizures within a 5 minute period. [symptoma.com]

  Mehta 2007 30 minutes of continuous seizure activity or two or more sequential seizures without full recovery of consciousness between seizures. [doi.org]

  […] activity.[7] It is of two main types with either prolonged complex partial seizures or absence seizures.[7] Up to a quarter of cases of SE are nonconvulsive.[7] In the case of complex partial status epilepticus, the seizure is confined to a small area [en.wikipedia.org]

  Both levetiracetam and lorazepam were equally effective in aborting seizures (RR 0.97, 95% CI 0.44 to 2.13). [ncbi.nlm.nih.gov]

• Stroke

  METHODS: All consecutive patients experiencing post-stroke SE (PSSE) in our center were included (2011-2016). We analyzed SE- and stroke-related factors in relation to the patients' outcome. [ncbi.nlm.nih.gov]

  Abstract Objective: To evaluate occurrence rate, clinical data, and prognostic factors of status epilepticus (SE) after stroke. [n.neurology.org]

  “Early” referred to seizures and SE occurring within 1 week after stroke that were considered to be provoked by the stroke. Unprovoked seizures and SE developing beyond 1 week after stroke were called “late.” [stroke.ahajournals.org]

• Confusion

  In the first type of NCSE, patients present with confusion or abnormal behavior, suggesting the diagnosis of absence status epilepticus (ASE) or complex partial status epilepticus (CPSE). [ncbi.nlm.nih.gov]

  Symptoms: Symptoms of status epilepticus include onset of muscle spasms, confusion, clenching of teeth, difficulty in breathing, loss of control over bowel movements, unusual behavior and difficulty in speaking. [symptoma.com]

  Confused, stuporous, or comatose patients may demonstrate rapid, rhythmic epileptiform discharge on the EEG, as shown here. [jaoa.org]

• Aphasia

  Six months later, the patient again exhibited global aphasia. Brain MRI showed tumefactive white matter lesion in the left temporo-parietal lobes. [ncbi.nlm.nih.gov]

  The first patient responded quickly to phenytoin: total aphasia remitted five minutes after phenytoin administration and completely disappeared 15 minutes later. In the second patient, Broca's aphasia disappeared spontaneously. [f1000research.com]

  Focal SE of language cortex typically causes aphasia, termed ictal aphasia. Diagnosis is primarily based on clinical findings. [emedicine.com]

• Urinary Incontinence

  incontinence Post-ictal period Injuries Initial investigation of a seizure Glucose Venous blood gas (VBG) Full blood count Urea & electrolytes Magnesium Calcium Further investigation of seizures or status epilepticus Guided by the likely cause but may [oxfordmedicaleducation.com]

At the preliminary level, a thorough physical examination would be carried out taking into consideration a past medical history. In addition, complete information about drugs would also be taken. Following this, an electroencephalogram would be carried out to measure the electrical activity of the brain [9].
Various other tests are also indicated such as lumbar puncture and spinal tap test in order to look for signs of infections. Imaging studies such as CT scan and MRI can also be required to check for any associated brain abnormalities [10].

• EEG Seizure Activity

  Propofol was given to suppress EEG activity Case report Observation of EEG activity Propofol appeared to suppress EEG seizure activity Case report Kuisma M and Roine RO 1995 Finland 8 adult patients in prehospital care with RSE. [bestbets.org]

• Hypercapnia

  Systemic changes requiring medical intervention include hypoxia, hypercapnia, hypoglycemia, metabolic acidosis, and other electrolyte disturbances. Table 1 7, 17 – 19 summarizes the physiologic changes that occur during status epilepticus. [aafp.org]

  Treat complications Resuscitation Attend to ABCS and address life threats Manage airway with recovery position, airway adjuncts and intubation if required Optimise oxygenation and provide ventilatory support as needed (prone to hypercapnia) Early IV or [litfl.com]

  With this approach, hypercapnia may occur. Hypercapnia (PaCO2 level up to 90 mm Hg) is generally well tolerated when oxygenation is maintained.14 Sedation is crucial to achieving optimal ventilation. [journalofhospitalmedicine.com]

• Lymphocytic Infiltrate

  Finally, a brain biopsy was done which revealed presence of lymphocytic infiltrate with SV40 inclusions in oligodendrocyte. [ncbi.nlm.nih.gov]

The primary goal of treatment would be to end the episode of seizure and bring the individual back to normal. Underlying problems also require treatment in order to treat status epilepticus.

If hypoglycemia is the cause of the seizure, then glucose load would be administered. Several anti-seizure drugs such as diazepam, valproate, phenytoin, phenobarbital, lorazepam and fosphenytoin are indicated for treating status epilepticus. Amongst these drugs, diazepam is usually the first choice and preferred for patients suffering from seizures. The drugs are either given through the intravenous route or through injections [11].

The prognosis of the condition is not very favourable. It has been estimated that 10-30% of individuals suffering from status epilepticus do not live longer than 30 days after the onset of first attack. Majority of these individuals are known to be suffering from certain underlying neurological conditions. In addition, other group of individuals with no known underlying disease condition also has significant risk of mortality, if their condition is not quickly stabilized with medications and therapies [7].

Individuals with history of epilepsy or those suffering from underlying neurological disorders are prone to develop status epilepticus. Individuals with history of epilepsy suffer from status epilepticus, probably due to change in medications. In addition, other factors or conditions that can trigger a structural damage in the cortical region can also significantly contribute to development of status epilepticus. These include [2]:

• Alcohol withdrawal
• Certain medications
• Stroke, tumor, trauma to the head or hypoxic injury
• Subarachnoid hemorrhage 
• Development of neoplasms
• Infections of the central nervous system
• Electrolyte imbalance
• Exposure to toxins

It has been estimated that about 50,000-200,000 individuals suffer from status epilepticus in US every year. It is known to be one of the most common emergencies presented in the neurological department. The estimated mortality rate of status epilepticus is about 20%. Individuals of all age groups are equally susceptible to suffer from this condition [3, 4].

According to the widely accepted definition of status epilepticus, seizures that last for 30 minutes or more are termed as status epilepticus. However, based on the new guidelines, any seizures that continue for 5 minutes or more should be treated as status epilepticus. During an attack of seizure, the body struggles to supply oxygen to the rest of the body parts; failure to do so can cause significant damage to the brain [5].

In addition, other physiologic changes also accompany an attack of convulsive status epilepticus. These changes can be defined by the onset of tachycardia, hyperglycemia and or cardiac arrhythmias. All these occur as a result of catecholamine surge, which accompany every attack of seizure [6].

Individuals with past history of epilepsy are advised against changing medications without the doctor’s advice. This is because such a practice can trigger an attack of status epilepticus. Avoiding alcohol and consumption of recreational drugs would also help in preventing the onset of seizures. Keeping blood sugar levels normal can also prevent occurrence of seizures.

Status epilepticus is a condition characterized by occurrence of seizures for a period of more than 30 minutes, or several seizures within a 5 minute period. In such a kind of condition, the individual does not return to normal state during the several attacks or seizures. It is one of the types of epileptic seizures, which is a life threatening condition. Individuals with certain type of underlying disease conditions or those with history of epilepsy are prone to suffer from status epilepticus. The condition is divided into 2 categories, namely convulsive status epilepticus and non convulsive epilepticus [1]. 

• Definition: Status epilepticus, is a condition characterized by onset of seizures for more than 5 minutes. In such a type of condition, there is abnormal electrical activity in the brain that severely affects mind and body functioning. It is a medical emergency which can lead to brain damage if not promptly treated. Individuals with history of epilepsy can suffer several attacks of status epilepticus.
• Cause: Individuals who have already suffered epilepsy in the past are more prone to develop status epilepticus. Underlying neurological disease conditions can also predispose an individual to develop such a type of epilepsy.
• Symptoms: Symptoms of status epilepticus include onset of muscle spasms, confusion, clenching of teeth, difficulty in breathing, loss of control over bowel movements, unusual behavior and difficulty in speaking. These are some of the common symptoms; individuals with convulsive or non-convulsive form experience different set of symptoms.
• Diagnosis: A past medical history inclusive of medications, disease profile and alcohol consumption is gathered. Following this, electroencephalogram is conducted to measure the electrical activity of the brain. Imaging studies such as CT scan and MRI of the brain is also indicated in order to diagnose other underlying disease conditions.
• Treatment: Treatment with anti-seizure medications forms the basis of treatment regime. These include diazepam, phenytoin, valproate, lorazepam, fosphenytoin and Phenobarbital. The drugs are either given intravenously or through injections.

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