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

  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. [symptoma.com]

  Copyright © 2018 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved. [ncbi.nlm.nih.gov]

  Epilepsy Research. 96 (1): 140–150. doi:10.1016/j.eplepsyres.2011.05.018. PMID 21676592. ^ Zhao, ZY; Wang, HY; Wen, B; Yang, ZB; Feng, K; Fan, JC (28 March 2016). [en.wikipedia.org]

  ORGANIZATIONS American Epilepsy Society. 342 North Main Street, West Hartford, CT 06117-2507. (860) 586-7505.. Epilepsy Foundation of America. 4351 Garden City Drive, Landover, MD 20785-7223. (800) 332-1000.. Internation League Against Epilepsy. [encyclopedia.com]

  Febrile Seizures Focal Epilepsy Grand Mal Epilepsy Jacksonian Epilepsy Lundborg-Unverricht Disease Major Epilepsy Minor Epilepsy Myoclonic Astatic Petit Mal Epilepsy Myoclonic Progressice Familial Epilepsy Myoclonic Seizure Petit Mal Epilepsy Petit Mal [rarediseases.org]

• 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]

  A) Fosphenytoin or Phenytoin - Preferred B) Paraldehyde or Phenobarbital During this time the team should obtain a brief history asking about any seizure disorders, other symptoms, fever, medication usage and allergies. [pedscases.com]

  In children, the major cause of status epilepticus is infections accompanied by fever. 3 In adults the main acute causes are: Stroke Hypoxia Metabolic derangements Alcohol intoxication or withdrawal (the most common cause in young adults) In people with [bmj.com]

• Inflammation

  This can lead to long-term neurological complications due to neuronal death, glia, neurological injury, aberrant neuroplasticity, oxidative stress and inflammation, and alteration of neuronal networks. [frontiersin.org]

  Idiopathic hypertrophic cranial pachymeningitis (IHCP) is an uncommon disease of unknown etiology characterized by thickening of the cerebral dura mater with possible associated inflammation. [ncbi.nlm.nih.gov]

  Other things that might lead to SE include: Low blood sugar HIV Head trauma Alcohol or drug abuse Kidney or liver failure Encephalitis (brain inflammation) When to Call 911 Convulsive status epilepticus is a medical emergency. [webmd.com]

  14.00 Lunch break & posters & conference photograph 14.00 - 16.00 Session 2: Biomarkers Chairs: Peter Crino, Claude Wasterlain 14.00 - 14.40 MicroRNAs as biomarkers and treatment targets in status epilepticus David Henshall 14.40 - 15.20 Biomarkers of inflammation [statusepilepticus.eu]

• Unconsciousness

  A 33-month-old girl presented with fever and seizure followed by unconsciousness for 6 hours. Physical examination showed 4 hypopigmented macules with diameters exceeding 5 mm. [ncbi.nlm.nih.gov]

  Convulsive epilepticus is when a patient physically convulses during a seizure and is unconscious. This is the more common type of status epilepticus and is considered a medical emergency. [texaschildrens.org]

  Once the clonic phase ends, you might stay unconscious for a few more minutes. This is the postictal period. [webmd.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]

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

  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]

• Tachypnea

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

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

  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]

• Hypertension

  The patient developed multiple postoperative complications but ultimately recovered after treatment for severe hypertension and seizures. [ncbi.nlm.nih.gov]

  subsequent hypotension Cardiac arrhythmias Pulmonary oedema Aspiration pneumonitis Intracranial hypertension Investigations Initial Subsequent Glucose, urea, creatinine, sodium, potassium, calcium Anti-convulsant levels Complete blood count Arterial [aic.cuhk.edu.hk]

  A 60-year-old female (with hypertensive emergency and respiratory failure requiring intubation) was transferred to the Neuroscience intensive care unit (NSICU) due refractory NCSE. [n.neurology.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 withdrawal may have abnormal vital signs including tachycardia, hypertension, hyperthermia and tachypnea. This is predominantly a clinical diagnosis. [saem.org]

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

  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

  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]

  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]

• Suggestibility

  Current evidence-based guidelines for management of status epilepticus propose medication algorithms with suggested times for each management step. [ncbi.nlm.nih.gov]

  Description of a postictal period by bystanders or paramedics is suggestive of seizure. [saem.org]

• 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]

  ⚠️ Urinary incontinence may occur with either seizure or pseudoseizure. evaluation and management When in doubt, video EEG capture can help make these distinctions. [emcrit.org]

• Seizure

  Focal seizures are referred to as simple partial seizures when cognition is not impaired and as complex partial seizures when cognition is impaired. [saem.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]

  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]

  Seizure. vol. 18. 2009 Jan. pp. 38-42. [clinicaladvisor.com]

• Stroke

  As far as stroke patients are regarded, ischaemic stroke occurred more frequently in all age groups, except for the patients aged between 65 and 80 years; the latter group was more often hit by haemorrhagic stroke. [frontiersin.org]

  January 25, 2000 ; 54 (2) Articles Report on a hospital-based stroke cohort L. Rumbach, D. Sablot, E. Berger, L. Tatu, F. Vuillier, T. [n.neurology.org]

  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]

  e.g. eclampsia infections accompanied by fever (the most important cause in children) CT In most instances, unless one of the underlying conditions is visible (e.g. stroke), CT of the brain will be unremarkable. [radiopaedia.org]

• Confusion

  A nonconvulsive epilepticus patient will not lose consciousness but may seem confused or absent. [texaschildrens.org]

  Seizure types include convulsive (is more likely to lead to long-term injury and may involve jerking motions, grunting sounds, drooling, and rapid eye movements) and nonconvulsive (may appear acutely confused, look like they're daydreaming, or may have [chestnet.org]

  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]

  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]

  Seizures may also be unwitnessed and a patient may present to the ED stating that they woke up confused or on the floor. [saem.org]

• Meningism

  Two other children had enteroviral meningitis (2/13 tested, 15%; 95% CI, 3%-51%), and 1 had a herpes simplex virus infection (1/47, 2%; 95% CI, 0%-15%). CONCLUSIONS: Bacterial meningitis is an uncommon cause of SE. [ncbi.nlm.nih.gov]

  Infections such as meningitis can cause status. [encyclopedia.com]

  Meningitis Meninges of the central nervous system: dura mater, arachnoid mater, and pia mater. [en.wikipedia.org]

  As many as 40 per cent of SE cases occur in patients with epilepsy, with head trauma, meningitis, and stroke making up much of the rest. [epilepsysociety.org.uk]

• 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]

  Impaired renal function increases the risk for Cefepime-induced neurotoxicity and symptoms range from disorientation, aphasia, myoclonus, status epilepticus, to coma and death. [n.neurology.org]

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

  […] require EEG seizure activity. [ajnr.org]

• Hypoglycemia

  These findings may suggest alcohol withdrawal, drug use, or hypoglycemia as possible causes of seizure. [saem.org]

  Because hypoglycemia may precipitate status epilepticus and is quickly reversible, 50 mL of 50 percent glucose should be given immediately if hypoglycemia is suspected. [aafp.org]

• Hyperglycemia

  Although hyperglycemia is an important cause of acute symptomatic seizure (ASS), patients with ketotic hyperglycemia develop ASS less frequently. [ncbi.nlm.nih.gov]

  […] consciousness between ≥ 2 discrete seizures Etiology Structural abnormalities stroke (most common in older adults) brain malignancy intracranial bleed head trauma arteriovenous malformations Infections meningitis encephalitis Metabolic abnormalities hypo- or hyperglycemia [step2.medbullets.com]

  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. [symptoma.com]

  […] consciousness between ≥ 2 discrete seizures Etiology structural abnormalities stroke (most common in older adults) brain malignancy intracranial bleed head trauma arteriovenous malformations infections meningitis encephalitis metabolic abnormalities hypo- or hyperglycemia [medbullets.com]

  It is accompanied by hyperactivation of the autonomic nervous system with hypertension, hyperglycemia, salivation and sweating, with steep increases in temperature way beyond normal range (hyperpyrexia). [news-medical.net]

• Hypercapnia

  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]

  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 [lifeinthefastlane.com]

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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