Status epilepticus

Status epilepticus
Generalized 3 Hz spike-and-wave discharges on an electroencephalogram
Specialty	Emergency medicine, neurology
Symptoms	Regular pattern of contraction and extension of the arms and legs, movement of one part of the body, unresponsive[1]
Duration	>5 minutes[1]
Risk factors	Epilepsy, underlying problem with the brain[2]
Diagnostic method	Blood sugar, imaging of the head, blood tests, electroencephalogram[1]
Differential diagnosis	Psychogenic nonepileptic seizures, movement disorders, meningitis, delirium[1]
Treatment	Benzodiazepines, fosphenytoin, phenytoin,[1] paraldehyde (rarely used)
Prognosis	~20% thirty-day risk of death[1]
Frequency	40 per 100,000 people per year[2]

Status epilepticus (SE), or status seizure, is a medical condition consisting of a single seizure lasting more than 5 minutes, or 2 or more seizures within a 5-minute period without the person returning to normal between them.^[3][1] Previous definitions used a 30-minute time limit.^[2] The seizures can be of the tonic–clonic type, with a regular pattern of contraction and extension of the arms and legs, or of types that do not involve contractions, such as absence seizures or complex partial seizures.^[1] Status epilepticus is a life-threatening medical emergency, particularly if treatment is delayed.^[1]

Status epilepticus may occur in those with a history of epilepsy as well as those with an underlying problem of the brain.^[2] These underlying brain problems may include trauma, infections, or strokes, among others.^[2][4] Diagnosis often involves checking the blood sugar, imaging of the head, a number of blood tests, and an electroencephalogram.^[1] Psychogenic nonepileptic seizures may present similarly to status epilepticus.^[1] Other conditions that may also appear to be status epilepticus include low blood sugar, movement disorders, meningitis, and delirium, among others.^[1] Status epilepticus can also appear when tuberculous meningitis becomes very severe.

Benzodiazepines are the preferred initial treatment, after which typically phenytoin is given.^[1] Possible benzodiazepines include intravenous lorazepam as well as intramuscular injections of midazolam.^[5] A number of other medications may be used if these are not effective, such as phenobarbital, propofol, or ketamine.^[1] After initial treatment with benzodiazepines, typical antiseizure drugs should be given, including valproic acid (valproate), fosphenytoin, levetiracetam, or a similar substance(s).^[6] While empirically based treatments exist, few head-to-head clinical trials exist, so the best approach remains undetermined.^[6] This said, "consensus-based" best practices are offered by the Neurocritical Care Society.^[6] Intubation may be required to help maintain the person's airway.^[1] Between 10% and 30% of people who have status epilepticus die within 30 days.^[1] The underlying cause, the person's age, and the length of the seizure are important factors in the outcome.^[2] Status epilepticus occurs in up to 40 per 100,000 people per year.^[2] Those with status epilepticus make up about 1% of people who visit the emergency department.^[1]