status epilepticus

Last edited 09/2018

The Commission on Classification and Terminology of the International League Against Epilepsy (ILAE) defines Status Epilepticus as:

“a seizure that persists for a sufficient length of time or is repeated frequently enough that recovery between attacks does not occur” (1).
There is no clear definition on the time period which a convulsion has to last before being classified as status epilepticus (SE) (2)

• originally, the ILEA defined SE as 30 minutes of sustained seizure activity or 2 or more seizures during this time period without a return to the baseline level of consciousness between  seizures (2)
• animal data have indicated that more than 30 minutes of continuous seizure activity may result in permanent neuronal injury and pharmacoresistance (3)  
• Lowenstein and colleagues have proposed a definition of SE based on seizures which are longer than 5 minutes or two or more discrete seizures without a return of consciousness between seizures (4) 

Status epilepticus is a medical emergency because of the 20% mortality and the high rates of neurological and systemic morbidity. Prolonged generalized SE can lead to death or permanent brain damage (5).

Prolonged or repeated seizures and convulsive status epilepticus

• buccal midazolam or rectal diazepam should only be prescribed for use in the community for children, young people and adults who have had a previous episode of prolonged or serial convulsive seizures
• administer buccal midazolam as first-line treatment in children, young people and adults with prolonged or repeated seizures in the community
  • administer rectal diazepam if preferred or if buccal midazolam is not available
  • if intravenous access is already established and resuscitation facilities are available, administer intravenous lorazepam

Reference:

• (1) Meierkord H et al. EFNS guideline on the management of status epilepticus in adults. Eur J Neurol. 2010;17(3):348-55. 
• (2) Walker M.Status epilepticus: an evidence based guide. BMJ. 2005;331(7518):673-7. 
• (3) Brophy GM et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17(1):3-23.  
• (4) National Clinical Guideline Centre (NCGC) 2012. The Epilepsies. The diagnosis and management of the epilepsies in adults and children in primary and secondary care.  
• (5) Manno EM. Status epilepticus. Current treatment stratergies. The Neurohospitalist  2011;1(1):23-31
• (6) NICE (April 2018). Epilepsies: diagnosis and management