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What is Status Epilepticus or Seizure?

It is a fatal form of epileptic activity in which the seizures do not cease on their own even after a considerable amount of time or recur one after another without the patient completely recovering in between. It is a medical emergency and the patient should be immediately taken under medical guidance.

Understanding Status Epilepticus:

All of us in our lives have either seen a person seizing or have an idea of what it is like from movies or television. However, in real life, it is important to identify a seizure that can be life-threatening. Seizures can be of multiple types and all of them can be dangerous. Status epilepticus is an uncontrolled seizure and can be identified as:

  • A seizure lasting for 30 minutes or more (Although steps to get medical care should be taken after 5 minutes of continuous seizing)
  • Two consecutive episodes of fits without the patient gaining complete consciousness in the time interval between episodes

Status epilepticus (SE) can be of two types: Partial and generalized. A partial seizure is one where only certain parts of the brain are affected and specific functions in distinguished areas are altered; whereas generalized seizure affects the entire brain and all body functions might be altered.

Generalized SE can further be divided into convulsive and non-convulsive.

What are the causes of Status Epilepticus?

  • Stroke
  • Sudden withdrawal from anti-epileptic medications
  • Imbalance in body metabolites like hypoglycemia or hyponatraemia (decreased sodium levels)
  • Alcohol withdrawal
  • Infections in the brain like meningitis
  • Brain tumor
  • After surgery for brain trauma or brain tumour

What are the risk factors for Status Epilepticus?

  • Trauma to the head
  • Stroke (in older adults)
  • Drug abuse
  • Previous history of epilepsy
  • History of epilepsy in the family
  • Genetic predisposition
  • Blood disorders
  • Sleep deprivation

Also Read: Stroke: What is Golden Hour?

What are the symptoms of Status Epilepticus?

Symptoms present based on the type of SE.

  • In a convulsive type of SE, regular patterns of contraction and relaxation of limb muscles are seen. Jerky movements throughout the body can be present
  • A nonconvulsive type of SE can be difficult to acknowledge and might be missed. The patient may have a blank stare, slow movements, confusion and discharge of saliva or urine
  • A partial seizure affects some parts of the brain and manifests in certain areas (focal seizures) of the body like the twitching of facial muscles

How is Status Epilepticus or a Seizure diagnosed?

  • Imaging of the brain using CT scan, MRI, etc
  • Blood sugar levels and full blood count
  • Serum levels of electrolytes and other metabolites
  • EEG: Electroencephalogram
  • Cerebrospinal fluid (CSF) examination to look for infections
  • Drug profile

What is the treatment for Status Epilepticus?

  • If a person is identified to be having status epilepticus, he/she must be immediately brought under medical attention
  • The patient is immediately given airway support, ventilation if needed, and correction of blood parameters is initiated
  • Diazepam or Lorazepam are anti-epileptic drugs given intravenously to control the seizure. Other drugs like Fosphenytoin, Valproate can also be given
  • More drugs if required can be added in orderly fashion depending on the recovery of the patient
  • EEG monitory is done
  • ICU admission might be required

What are the complications with Status Epilepticus?

  • Tongue bite and fractures are the common complications that occur during the episode
  • Head injury (due to falling during a seizure)
  • Long-term complications include epilepsy, focal neurological deficits, and encephalopathy (due to neuronal damage)

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