Status Epilepticus

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.

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].

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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