Definition

Status epilepticus is a seizure that continues for five minutes or more without any periods of consciousness between seizures. It is a medical emergency and can cause permanent damage, so immediate treatment is necessary.

Status epilepticus can occur at any age, from children to the elderly, but it is most common in children. Recognizing the symptoms involves identifying two common types of seizures: convulsive and non-convulsive. Convulsive seizures involve visible jerking of the entire body, while non-convulsive seizures are marked by changes in consciousness, such as confused behavior.

Causes

The causes of status epilepticus vary by age. In children, the most common cause is fever due to infection. In adults, prolonged seizures are often caused by stroke or head trauma. Other causes include vascular disorders, autoimmune diseases, cancer, and metabolic disturbances like low blood sugar, electrolyte imbalance, and drug overdose. Blood sugar levels that can cause seizures are 20-30 mg/dL. Seizures can also occur without any known cause.

Seizures occur when there is abnormal electrical activity in the brain, leading to excessive activity of nerve cells. This can be triggered by structural abnormalities in blood vessels or high body temperature, resulting in rigid and repetitive movements or unresponsiveness. Seizures can happen suddenly and may occur more than once or repeatedly.

Risk factor

Several risk factors can make someone more prone to status epilepticus, including:

• Uncontrolled epilepsy
• Low blood sugar levels
• Stroke
• Kidney failure history
• Liver failure history
• Encephalitis
• HIV
• Alcohol and drug abuse
• Head trauma
• Metabolic disorders (e.g., low blood sugar, electrolyte imbalance)
• Low oxygen levels in the blood
• Emergency-level high blood pressure
• Genetic disorders

Symptoms

The primary symptom of a seizure is unconsciousness, accompanied by one or more of the following symptoms affecting part or all of the body simultaneously:

• Muscle stiffness
• Falling
• Confusion
• Unusual vocal sounds
• Loss of bladder or bowel control
• Jaw stiffness
• Irregular breathing
• Unusual behavior
• Speech difficulties
• Blank stare
• Numbness in certain body areas
• Sensory disturbances (e.g., vision or smell)

Diagnosis

Diagnosing status epilepticus involves interviewing the patient's family or close contacts and conducting additional tests to determine the cause of the seizure. Healthcare professionals will perform a physical examination while asking about the timing and duration of the seizure and the events before and after it. Medical history is crucial for accurate diagnosis.

Additional diagnostic tests include:

• CT scan: Commonly used for its speed and accuracy in viewing brain and surrounding structures.
• Magnetic Resonance Imaging (MRI): Provides a clearer view of brain structures, especially in children, but takes longer to perform and may require sedation.
• Electroencephalogram (EEG): Uses sensors attached to the scalp to record brain electrical activity.
• Laboratory tests: Includes complete blood count, electrolyte levels, urea, creatinine, bicarbonate levels, and cerebrospinal fluid analysis to identify possible seizure causes. The time for results can range from minutes to hours, depending on available equipment.

Management

Treatment during a seizure aims to stop it as quickly as possible and address the underlying cause. Emergency actions include securing the airway and checking circulation. Initial treatments involve oxygen and establishing an intravenous (IV) line for medication and fluids. Blood sugar levels are checked immediately, with intravenous glucose given if levels are low.

Medications used to stop seizures include:

• Diazepam
• Lorazepam
• Phenytoin
• Fosphenytoin
• Phenobarbital
• Valproic acid

These medications can be administered via IV or direct muscle injection. It's essential to inform healthcare providers of any drug allergies. After medication administration, the patient is closely monitored. If initial treatments fail, additional anti-seizure or sedative medications are used. Pregnant women receive magnesium sulfate instead.

Complications

The most dangerous complication of status epilepticus is death, with a 30-day mortality rate of 19-27%. Prolonged seizures can cause permanent brain damage and circulatory issues, closely linked to the seizure's cause. Effective seizure control can prevent permanent brain damage. Head trauma or stroke can lead to lasting brain damage, disability, or death.

Prevention

Status epilepticus can be prevented in individuals with epilepsy, defined as having at least two unprovoked seizures occurring at least 24 hours apart. Prevention involves regular anti-seizure medication, avoiding alcohol and illicit drugs, and maintaining stable blood sugar levels.

When to see a doctor?

Immediate medical attention is required if a loved one experiences:

• Complex seizures in children
• Seizures with stiff neck
• Unconsciousness
• Seizures in infants with bulging fontanelles
• Rapid heartbeat or breathing difficulties

Seizures, especially status epilepticus, are emergencies and can be life-threatening. Prompt hospital treatment is crucial.

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