Status Epilepticus

Status epilepticus (SE) is defined as a condition in which a patient has a prolonged seizure or has recurrent seizures without fully recovering in the interval. With respect to the most severe seizure type (primary or generalized tonic-clonic) a duration of 5 min is sufficient for diagnosis of status epilepticus. SE

may occur in a person with chronic epilepsy (the most frequent cause being noncompliance) or in a person with an acute systemic or brain disease (such as hypoglycemia or stroke). The classification of SE follows the international classification of epileptic seizures. In clinical praxis, often only two major types are distinguished: convulsive and nonconvulsive status epilepticus. SE, particularly convulsive SE, is a life-threatening condition that requires emergency treatment. Prolonged seizure activity causes systemic complications and brain damage.

The incidence of SE is 50/100,000. In all studies the convulsive type is most common (80%). However, nonconvulsive SE is difficult to recognize and may therefore be underrepresented in epidemiological studies. Mortality of SE is on the order of 20%. Prognosis and response to treatment largely depend on the etiology of SE. SE occurring in the context of chronic epilepsy has a much better outcome than SE complicating acute processes (such as hopoxemia). SE should always be managed on an emergency ward. Traditionally, drug treatment of SE includes the immediate intravenous administration of a fast-acting benzodiazepine such as diazepam plus phenytoin. Alternatively, lorazepam may be used alone because its pharmacokinteics are such that the medium-term control is comparable to that of phenytoin. If SE persists, phenobarbitone is an alternative, with the next step being a general anesthesia using pentobarbi-tal or propofol.

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