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?
- 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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