Status Epilepticus

There are an estimated 100,000 to 150,000 cases of status epilepticus per year in the United States, with 55,000 deaths. In 12 to 30 percent of these, status is the first epileptic event.1 I6 Estimations of acute mortality range from 1 to 10 percent.

Status epilepticus is defined as either continuous seizure activity 30 min or more, or two or more seizures that occur without full recovery of consciousness between the attacks. It remains unclear how long a seizure can occur before permanent neurologic sequelae ensue. Although this question has never been satisfactorily answered, it does appear that permanent CNS injury is more likely to occur the longer seizures are allowed to progress. 118 Thus treatment should be initiated as soon as possible in all patients with continuous seizure activity lasting more than 10 min. The longer the seizure is allowed to continue the more difficult it will be to control.19

The diagnosis of status epilepticus is usually obvious in patients with continuous tonic-clonic movements. However, convulsive activity may gradually lessen over time or with partial treatment, giving the impression that the seizures have been controlled, with continued subtle signs such as nystagmus, or twitching of the face, hands, or feet. Correct diagnosis requires a high index of suspicion, a perceptive physician, and sometimes an EEG. Any type of seizure may occur continuously or in rapid succession, fulfilling the criteria for status epilepticus. Epilepsia partialis continue is repeated partial seizures without loss of consciousness and often with one's ability to follow simple commands retained. Altered mentation, diminished responsiveness, confusion, amnesia, or dream-like states without motor symptoms suggest continuous absence seizures.

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