Management of status epilepticus

Abstract

Status epilepticus (SE) is defined as a condition characterized by an epileptic seizure that is so frequently repeated or so prolonged as to create a fixed and lasting condition. Any type of epileptic seizure can develop into SE. Status epilepticus can be classified as generalized convulsive, non-convulsive and simple partial. Generalized convulsive SE includes tonic clonic seizures with either a partial or a generalized onset. Generalized tonic clonic status is defined when consecutive seizures occur without recovery of consciousness between them. Generalized tonic clonic SE is a medical emergency associated with a high morbidity and mortality if untreated. The most common etiology of SE is non-compliance to antiepileptic drugs. Other causes include alcohol withdrawal, cerebrovascular lesions, drug intoxication, central nervous system infections, neoplasms and acute metabolic derangements. The metabolic-biochemical complication of SE includes respiratory and metabolic acidosis, anoxia, hyperazotemia, hyperkalemia, hypoglycemia, hyponatremia and autonomic and endocrine dysfunctions. Prognosis of SE depends on the duration and etiology of SE. Vigorous treatment of SE is recommended. Effective medical treatment of SE includes Benzodiazepines, Phenytoin, Barbiturates and several other new antiepileptic drugs. In this presentation, we discuss the updated management of SE and propose a protocol for management of convulsive SE.