Status epilepticus is defined as a seizure lasting >30 minutes, or multiple seizures over 30 minutes with incomplete resolution

Aetiology

Precipitants of status

• Severe metabolic disorders - hyponatraemia, pydidoxine deficiency
• Infection
• Head trauma
• Sub-arachnoid haemorrhage
• Abrupt withdrawal of anti-convulsants
• Treating absence seizures with CBZ

Pathophysiology

Types

• Generalised convulsive status epilepticus
  • Generalised convulsions without cessation
  • Excess cerebral energy demand and poor subtrate delivery causes lasting damage - glutamate release, excitotoxicity, neuronal death
  • Can cause: respiratory insufficiency and hypoxia, hypotension, hyperthermia, rhabdomyolysis
• Non-convulsive status - conscious but in 'altered state'
• Epilepsia partialis continua - continual focal seizures, consciousness preserved
  • The possibility of partial status epilepticus should be considered in any patient presenting with an acute confusional state
  • Confirm diagnosis with EEG recording
  • Drug treatment and investigation as for convulsive status short of general anaethesia and ITU admission
  • Seek specialist advice in refractory cases

Clinical features

• Continuous seizure activity lasting more than 30 mins
• It should be assumed at 5 minutes and appropriate treatment and investigations initiate

Investigations

• Identify cause after stabilising patient - emergency blood tests +/- CT

Management