A seizure involves abnormal electrical activity in the brain affecting both the mind and the body. Many problems can cause you to have a seizure. These include high fever, brain infections, abnormal sodium or blood sugar levels, or head injuries. If you have epilepsy , you may have seizures repeatedly.
A seizure that lasts longer than 5 minutes, or having more than 1 seizure within a 5 minutes period, without returning to a normal level of consciousness between episodes is called status epilepticus. This is a medical emergency that may lead to permanent brain damage or death. Status epilepticus is very rare, most people with epilepsy will never have it. This condition is more common in young children and elderly adults.
In children, the main cause of status epilepticus is an infection with a fever. In adults, the common causes include:. Your healthcare provider may also order an electroencephalogram. This involves placing painless electrodes onto your scalp to measure the brain's electrical activity. You may need other tests to search for possible causes. Studies note that between 30 percent and 44 percent of status epilepticus cases are in people previously diagnosed with epilepsy.
In children, nearly 70 percent of cases are in those with diagnosed epilepsy, and skipping medication was believed to be a major cause. Research shows that Black people are significantly more likely than those of other races to experience status epilepticus. Researchers suspect this is due, at least in part, to socioeconomic factors that may influence the ability to access treatment. Death from status epilepticus is more common in men than in women, and it grows more common with age.
Children under 10 have the best outcomes, with deaths in less than 3 percent of cases. That goes up to 30 percent for adults. Status epilepticus can be diagnosed by clinical observation, but most often an electroencephalogram EEG , brain imaging, or lumbar puncture is needed to verify the diagnosis.
Diagnosing status epilepticus and identifying the cause is important because status epilepticus requires different treatment than the other conditions that have similar symptoms. Status epilepticus is a medical emergency.
It can cause death due to physical injury, choking, or as a result of the seizure itself. The episode may cause lasting brain damage, which can result in worsening seizures, increased predisposition to status epilepticus, and cognitive decline. If you or your child is prone to this condition, your healthcare provider will give you a prescription for an injectable anti-convulsant.
For a baby, you may be given a form that's delivered in the rectum. The American Epilepsy Society has made recommendations for the treatment of status epilepticus.
First-line medications for status epilepticus include:. If the initial drug doesn't work, emergency medical staff may use a second drug, such as:. These medications act quickly, and their effects do not typically last for longer than a few hours.
They can cause worsening of symptoms for people who do not have epilepsy. For example, lorazepam can make encephalopathy worse. When status epilepticus is triggered by medical problems, it is important to treat these conditions once the seizures are controlled. Treatment approaches for related conditions may include:. If you or your child has experienced status epilepticus, you're well aware of how frightening it can be. It is important to recognize the symptoms that occur right before the seizure and to take medication to try to prevent it.
Manifestations of SE are highly diverse, and outcomes are influenced by different variables. With this in mind, an EEG could be regarded as the most important prognostic biomarker when evaluating the prognosis of a patient with SE.
The etiology of SE did not have an effect on the outcome. The two major etiologies in this study were cerebrovascular disease and alcohol misuse. Both acute symptomatic and remote symptomatic seizures caused by stroke are known to be associated with an increased risk of long-term mortality [ 11 ].
The misuse of alcohol, especially during withdrawal from drinking, is a common problem in the ED. The prognosis of these patients depends on other risk factors, such as TBI and metabolic problems. External toxicological agents, the elimination of which may improve prognosis, primarily cause pure withdrawal seizures. The overall prognosis was favorable, although there were patients with prolonged postictal state.
The sample size was not sufficient to answer the question about the variables affecting the outcome of different disease groups. However, it is possible that those patients with alcohol-related seizures had underlying although unknown precipitating factors worsening the prognosis.
In addition, we did not have a possibility to evaluate the long-term prognosis of these patients. The small proportion of patients with TBI in the present study is explained by the fact that, in TBI patients, the SE is usually a secondary complication of the primary disorder. We did not find patients with low AED blood concentrations in this study. This problem as an underlying cause of SE is difficult to prove because the majority of epilepsy patients use new AEDs, which do not require monitoring of the blood concentrations.
However, the measurement of serum drug levels in the treatment of SE would be important in evaluating the possibility of non-compliance and other causes of inadequate AED dose. In a previous study, the long-term mortality rate was higher in patients with acute symptomatic SE, but that study differed from ours because it included patients with myoclonic SE after anoxic encephalopathy [ 15 ]. We included only patients with a diagnosis of SE upon admission to the hospital but not patients with anoxia.
The existence of cardiovascular disease was associated with a worse outcome: two-thirds of the patients with cardiovascular disease had poor outcome. This finding supports the use of a holistic perspective in evaluating patients in the acute setting. The impact of the first-line treatment in the out-of-hospital stage was surprisingly small. There were no differences in disability or later relapses between the patients with or without treatment at the out-of-hospital stage.
However, in all of the study patients, SE was treated very aggressively immediately upon arrival at the ED. In the present study, there were no patients receiving intramuscular midazolam, which has proved effective compared with intravenous administration of lorazepam [ 17 ].
There are some weaknesses of this study. The small proportion of epilepsy patients with prolonged seizures is diagnosed only with their chronic epilepsy diagnosis number.
Missing data on delays weaken the applicability of the results; however, very long delays in a proportion of patients warrants the need for development of the emergency medicine system.
We included only patients with SE at admission to the ED, not those patients with SE as a complication of their primary disease leading to the treatment in the hospital. As a result, this study concentrates on the treatment of the SE in the ED. To conclude, this study demonstrates which clinical factors are important in evaluating patients with SE in the ED. Neurology , — J Clin Neurophysiol , — Neligan A, Shorvon SD: Frequency and prognosis of convulsive status epilepticus of different causes: a systematic review.
Arch Neurol , — PubMed Article Google Scholar. Epilepsia , — Epilepsia , 27— Commission on Classification and Terminology of the International League Against Epilepsy: Proposal for revised classification of epilepsies and epileptic syndromes. Article Google Scholar. Stroke , — Neurosurgery , — Electromyogr Clin Neurophysiol , — Neurocrit Care , 7: — N Engl J Med , — Do you have Poorly controlled seizures?
A known cause of seizures, such as infection, stroke, brain tumor? Problems remembering medicines? Difficulty taking medicines on a consistent schedule? Problems affording medicine? Seizures during sleep? Live alone? Low blood levels of medicine? More seizures during medicine changes? Taking many seizure medicines? Do you have problems taking medications?
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