Status Epilepticus

Status epilepticus (SE) is a life-threatening disorder in which the brain is in a persistent state of seizure (defined as fives minutes or more of a continuous seizure, or two or more discrete seizures without complete recovery of consciousness between seizures).1

Symptoms

Acute symptoms of status epilepticus (SE) may include the following: a seizure lasting more than five minutes, or more than one seizure in a row without regaining consciousness in between, muscle spasms, falling, confusion, unusual noises, loss of bowel or bladder control, clenched teeth, irregular breathing, unusual behavior, difficulty speaking and/or a "daydreaming" look.2 Status epilepticus is a medical emergency, which, if it is not rapidly controlled, may require emergency or intensive care.

Treatment

Upon diagnosis of status epilepticus (SE), doctors will work to identify and treat any underlying problems causing the patient’s seizure(s). The doctor may give the patient oxygen, take blood samples and put an intravenous (IV) line into a vein. The patient may also be given glucose (sugar) if low blood sugar is causing the seizure.3

If initially unsuccessful, the patient is treated with benzodiazepines. If no response, the patient is then treated with other, second-line, anti-seizure drugs. If the seizure persists after the second-line therapy, the patient is diagnosed as having refractory SE (RSE), admitted to the ICU and placed into a medically induced coma. Currently, there are no therapies that have been specifically approved for RSE; however, physicians typically use anesthetic agents to induce the coma and stop the seizure immediately.

After a period of 24 hours, an attempt is made to wean the patient from the anesthetic agents to evaluate whether or not the seizure condition has resolved. Unfortunately, not all patients respond to weaning attempts, in which case the patient must be maintained in the medically induced coma. At this point, the patient is diagnosed as having super-refractory status epilepticus (SRSE). Currently, there are no therapies specifically approved for SRSE, but we are fearless in our pursuit to change this.

References

1) Elsevier, Clinical Key. Status Epilepticus Causes, Diagnosis & Treatments. (n.d.). Retrieved September 11, 2014.
2,3) Johns Hopkins Medicine Health Library. Status Epilepticus Causes, Diagnosis & Treatments. (n.d.). Retrieved September 11, 2014.