Ass. Prof. Hadi Mujlli MSc, PhD Neurology Head of Med. Dep. Thamar Medical College, Thamar University
Definition Prolonged or clustered seizures sometimes develop into non-stop seizures. Status epilepticus (SE) is a common, life-threatening neurologic disorder that is essentially an acute, prolonged epileptic crisis. Status epilepticus is a medical emergency. Prolonged or clustered seizures sometimes develop into non-stop seizures,
Status epilepticus is a medical emergency. It requires hospital treatment to bring the seizures under control. If your child has had episodes of non-stop seizures that had to be treated in the emergency room, you will want to have a plan of action ready in case they occur again.
SE can represent an exacerbation of a preexisting seizure disorder, the initial manifestation of a seizure disorder, or an insult other than a seizure disorder. In patients with known epilepsy, the most common cause is a change in medication. Most seizures terminate spontaneously.
Signs and symptoms By clinical history, nonmotor simple partial status epilepticus involves subjective sensory disturbances, including the following: Focal or unilateral paresthesias or numbness Focal visual changes, usually characterized by flashing lights Focal visual obscuration or focal colorful hallucinations Olfactory or gustatory hallucinations Atypical rising abdominal sensations
Epilepsy partialis continua, or focal status epilepticus of the motor cortex, may occur in various contexts, with some authors subdividing it into type I (nonprogressive) and type II (progressive).
Type I epilepsy partialis continua features include the following: Intermittent, semi-rhythmic, involuntary twitching involving a discrete subset of muscles Most commonly affects the face and ipsilateral distal hand musculature Myoclonus of this variety may evolve into partial or generalized convulsion
Type II epilepsy partialis continua features include the following : Usually linked with Rasmussen encephalitis Gradual loss of unilateral function, with parallel focal or unilateral hemispheric atrophy Impaired intellectual skills to various degrees Possible effect on language skill s
Type I complex partial status epilepticus refers to recurrent, recognizable complex partial seizures without recovery between seizures. Type II represents continuous, ongoing complex partial seizure activity.
Diagnosis Examination for status epilepticus includes the following: - Generalized convulsive status epilepticus: Typical rhythmic tonic-clonic activity, impaired consciousness. - Status epilepticus due to possible mass lesion or brain infection. - Any patient without improving level of consciousness within 20-30 minutes of cessation of generalized seizure activity
Pharmacotherapy Most patients with status epilepticus who are treated aggressively with a benzodiazepine, fosphenytoin, and/or phenobarbital experience complete cessation of their seizures. If status epilepticus does not stop, general anesthesia is indicate d.
laboratory studies - Glucose and electrolyte levels (including calcium, magnesium) - Complete blood count - Renal and liver function tests - Toxicologic screening and anticonvulsant drug levels
Other tests - Electroencephalography - Blood cultures - Urinalysis and/or cerebrospinal fluid analysis - CT scanning and/or MRI of the brain - Chest radiography
Management Aggressive treatment is necessary for status epileptics. Clinicians should not wait for blood level results before administering a loading dose of phenytoin, regardless of whether the patient is already taking phenytoin.
Essential update: Ketamine treatment in refractory status epilepticus In a retrospective review of patients with status epilepticus refractory to typical antiepileptic drugs, ketamine was found to be effective and safe as an adjunctive treatment in all the patients
Supportive therapy - Maintenance of vital signs Airway, breathing, circulation (eg, hemodynamic/cardiac monitoring) - Respiratory support, with intubation and/or mechanical ventilation if necessary - Periodic neurologic assessments
Surgery - Surgical intervention for status epilepticus is a last resort and rarely performed - Operative procedures depend on the etiology - hemispherectomy, subpial resection, or placement of a vagus nerve stimulator.