Pdf status epilepticus is an increasingly recognized public health problem in the united states. Convulsive status epilepticus requires emergency treatment by trained medical personnel in a hospital setting. The pathophysiology of status epilepticus suggests that. Status epilepticus in adults john p betjemann, daniel h lowenstein status epilepticus is a common neurological emergency with considerable associated healthcare costs, morbidity, and mortality. This expanded edition represents the state of the art and captures many changes in our understanding of status epilepticus over the past decade.
Refractory status epilepticus rse can be defined as status epilepticus that continues despite treatment with benzodiazepines and one antiepileptic drug. Assess the impact of timing of status epilepticus treatment initiation, and develop strategies to optimize effective treatment. Efns guideline on the management of status epilepticus in adults h. They were subsequently adopted by the advanced life support group alsg and taught in their courses across the uk and europe. A maintenance drug should be initiated early in the course of status and continued at an adequate dosage. This guideline focuses on convulsive status epilepticus because it is both the most common type of status epilepticus and is associated with substantial. Status epilepticus is a dangerous situation historically defined as a seizure or a cluster of seizures lasting longer than 30 minutes without improvement in consciousness. Status epilepticus vanderbilt university medical center.
In a clinical trial of adults with in hospital status epilepticus. An update on the management of status epilepticus in adults. Status epilepticus is a common neurological emergency with considerable associated healthcare costs, morbidity, and mortality. Status epilepticus is when a seizure lasts longer than 5 minutes or when seizures occur close together and the person doesnt recover between seizures. A lifethreatening neurological condition defined as 5 or more minutes of either continuous seizure activity or repetitive seizures without regaining consciousness. Proposed algorithm for convulsive status epilepticus from treatment of convulsive status epilepticus in children and adults, epilepsy currents 16. Status epilepticus is a very serious, although rare seizure condition. Therefore, this 30minute definition is not used in clinical practice. Amongst those whose seizures lasted longer than 30 minutes, 02% mortality has been reported due to the seizure itself. Status epilepticus journal of association of physicians. Convulsive status epilepticus cse is the most common neurological medical emergency and continues to be associated with significant morbidity and mortality. There are numerous reasons for why one might have a seizure, and of these the majority can by extension of their magnitude become causes of status epilepticus.
The factors that suggest a poorer outcome in terms of seizures, cognition, and behaviour include the presence of. A definition and classification of status epilepticus report of the ilae task force on classification of status epilepticus. It is a serious condition that requires prompt medical attention. Status epilepticus symptoms, diagnosis and treatment. Physicians should rely on a standardized protocol for management of status epilepticus to. A patient in status epilepticus has continuous or rapidly repeating seizures. Guidelines for the evaluation and management of status. Although the danger of this pattern of seizure activity has been recognized since antiquity, our understanding of the p. Efns guideline on the management of status epilepticus in. Status epilepticus with convulsions may be more likely to lead to longterm injury. Status epilepticus literally means a continuous state of seizure. Ramadan, and the henry ford hospital, detroit, mi dr.
Proposed algorithm for convulsive status epilepticus. Evaluation and management of status epilepticus in the. Mortality in convulsive status epilepticus is less common in children than adults. We comment on our preference for drugs with a short elimination halflife and discuss some therapeutic choices. When seizures do not improve, on their own or with medication, they can cause brain damage or even death. The management of status epilepticus involves the rapid termination of seizure activity, airway protection, the taking of measures to prevent aspiration, the management of potential precipitating causes, the treatment of complications, the prevention of recurrent seizures, and the treatment of any underlying conditions. This implies not only an actual epileptic diagnosis, but also promises that an immediate antiepileptic treatment will most likely improve the condition. Our approach to the epilepsies in childhood has been clarified by the broad separation into benign and malignant syndromes.
We searched medline and embase for relevant literature from 1966 to january 2005 and in the current updated version all pertinent publications from january 2005 to january 2009. In status epilepticus seizures appear in close succession or dont stop. Status epilepticus is defined as a continuous seizure lasting for at least 2030 minutes, or two or more discrete seizures between which the patient does not regain consciousness. In this lesson we will learn about status epilepticus pathophysiology and what causes it. Status epilepticus international league against epilepsy. For the weird causes, there is a good article which lists a massive spectrum of toxins, genetic diseases, rare autoimmune conditions and what have you. Our practice has been to treat with bicarbonate if the patient is hypotensive and arterial ph is epilepticus. Varied characteristics and treatment approaches, the growing use of continuous eeg monitoring, and insights into the underlying biology and. Protocol for management of inpatient status epilepticus in adults convulsive status epilepticus convulsive status epilepticus is a life threatening medical emergency. Guidelines for the evaluation and management of status epilepticus. The incidence of status epilepticus around richmond va, usa was 41 per 00 individuals per year.
Varelas, md, phd, fncs clinic from the johns hopkins hospital, baltimore, md dr. Status epilepticus is very rare, most people with epilepsy will never have it. The main causes of status epilepticus are low blood concentrations of antiepileptic drugs in patients with chronic epilepsy 34%, remote symptomatic causes 24%, cerebrovascular accidents 22%, anoxia or hypoxia. In a third of adults in status epilepticus, arterial ph falls below 7. Comparison of status epilepticus with prolonged seizure episodes lasting from 10 to 29 minutes. Pdf as in clark and prouts classic work, we identify three phases of generalised convulsive status epilepticus, which we call impending. A lifethreatening neurologic condition defined as 5 or more minutes of either continuous seizure activity or repetitive seizures without regaining consciousness. Guidelines for treating convulsive status epilepticus in children published in 2011 the original guidelines for the treatment of convulsive status epilepticus cse were published in 2000. We then summarise the data on the utility of extended eeg monitoring and emphasise the importance of early termination of status epilepticus. For someone who has seizures, theyre normally similar in length each time they occur and. Neurocritical care society status epilepticus guideline writing committee. Management of refractory status epilepticus in adults. Management of status epilepticus in adults journal of. Status fast facts first described on tablets from 718612 bc incidence.