Neurology · MU Sofia

65. Status epilepticus

Covers the definition of status epilepticus as a seizure lasting over five minutes or repeated seizures without recovery of consciousness, then sets out three types: convulsive, non-convulsive and focal. It describes causes in people with epilepsy and acute symptomatic causes, the proposed mechanisms of persistent neuronal excitation, clinical features with a picture, and complications. It ends with diagnostic tests, a stepwise emergency treatment plan from stabilisation through benzodiazepines and long-acting drugs to refractory cases, and differential diagnoses.

Inside: 1 section · 1 labelled picture · 14 flashcards · 2 min

Topic 65 of 88 in the MU Sofia syllabus for Neurology (Medicine, Year 4). The free AceMed note covers it in 1 section, about 252 words (2 min of reading), with 14 flashcards.

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  1. Status epilepticus

Status epilepticus

Definition

Status epilepticus (SE) is a neurological emergency characterized by:

  • A seizure lasting >5 minutes, or
  • Recurrent seizures without recovery of consciousness between attacks.

Prolonged seizures can lead to irreversible neuronal injury, brain damage, and death.

Classification

1. Convulsive Status Epilepticus (Most Common): Continuous generalized tonic-clonic seizures. Medical emergency

2. Non-Convulsive Status Epilepticus: Altered mental status. Confusion. Reduced responsiveness. EEG shows ongoing seizure activity

3. Focal Status Epilepticus: Persistent focal motor, sensory, or autonomic seizures

Etiology

  • In Patients with Epilepsy: Sudden withdrawal of antiepileptic drugs. Poor compliance. Sleep deprivation
  • Acute Symptomatic Causes: Stroke.CNS infections. Head trauma. Brain tumors. Hypoglycemia. Electrolyte disturbances. Alcohol withdrawal

Pathogenesis

Persistent neuronal excitation:

  • Excess glutamate activity
  • Failure of GABA-mediated inhibition
  • Increased metabolic demand
  • Cerebral hypoxia and neuronal injury

Clinical Features

  • Convulsive Status Epilepticus: Repeated tonic-clonic seizures. Loss of consciousness. Cyanosis. Tongue biting. Urinary incontinence
  • Non-Convulsive Status Epilepticus: Confusion. Behavioral changes.Staring. Decreased responsiveness

Complications: Cerebral edema. Hyperthermia.Respiratory failure. Cardiac arrhythmias. Metabolic acidosis. Permanent brain damage.Death

Diagnosis

Clinical Diagnosis: Do not delay treatment while waiting for investigations.

EEG

  • Most important for: Non-convulsive status epilepticus. Confirming ongoing seizure activity

Laboratory Tests: Blood glucose.Electrolytes.CBC. Renal and liver function. Toxicology screen

Neuroimaging: CT/MRI to identify underlying cause.

Treatment (Emergency)

Step 1: Stabilization

  • ABC: Airway. Breathing. Circulation
  • Check blood glucose immediately.

Step 2: Benzodiazepines (First-Line): Lorazepam IV (preferred). Diazepam IV. Midazolam

Step 3: Long-Acting Antiepileptic Drug: Levetiracetam. Valproate. Phenytoin/Fosphenytoin

Step 4: Refractory Status Epilepticus

  • If seizures continue: General anesthesia. ICU admission. Continuous EEG monitoring

Differential Diagnosis: Psychogenic non-epileptic seizures. Syncope. Metabolic encephalopathy. Acute stroke

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