Comparison of Status Epilepticus with Prolonged Seizure Episodes Lasting from 10 to 29 Minutes

Abstract

Summary:Purpose: Status epilepticus (SE) is a major medical and a neurologic emergency associated with significant morbidity and mortality. The current definition of SE is continuous seizure activity or intermittent seizure activity without regaining consciousness, lasting a 3 0 min. Epilepsy monitoring unit data indicate that many seizures self-terminate within minutes. Thus consideration was recently given to include seizure episodes lasting 3 1 0 min in the definition of SE. Because no large studies have been conducted on seizures lasting 10-29 min, this study was initiated to compare cases of SE and 10 to 29-min seizure episodes seen within the same period.Methods: Patients seen at the Medical College of Virginia Hospitals of Virginia Commonwealth University over the same 2-year period were studied. Two hundred twenty-six prospective SE cases (91 children and 135 adults) and 81 retrospective 10-to 29-min seizure episodes (31 children and 50 adults) were compared. A standardized data-entry-form system was compiled on each patient and was used to evaluate the data collected.Results: The 10-to 29-min seizure patients and the SE cases had similar demographic characteristics, such as sex, race, and age, and also had similar etiologies. The majority (93%) of SE cases required anticonvulsant (AED) treatment to control and stop seizure activity. In the 10-to 29-min group, 43% stopped seizing spontaneously, and the remainder (57%) required AED treatment to stop seizure activity. The mortality for the SE patients was 19% compared with 2.6% for 10-to 29-min group (p < 0,001). In the 10-to 29-min group that stopped seizing spontaneously, the mortality was 0. In the 10-to 29-min patients that required AED treatment, the mortality was 4.4%.Conclusions: The results demonstrate that a significant number of patients experience seizure activity lasting from 10-to 29-min. Approximately half of these seizure events stopped spontaneously and did not require AED treatment. The other half of the patients responded quickly to medications and stopped seizing before the 30-min definition for SE. The overall mortality of this group was significantly lower than that of the patients with SE. The results demonstrate that further studies on the 10-to 29-min seizure group are needed to differentiate seizures that will stop spontaneously and those that will only stop with AED treatment. Because almost half of the prolonged seizures stopped spontaneously, further studies are needed before including prolonged seizure activity in the definition of SE.

Clinical Profile of SE in Children in a Tertiary Care Hospital in Bihar

“…In our study with acute cause of SE, there was trend toward worse outcome. Duration of SE is the only potentially modifiable determinant of mortality [23]. Unfortunately, issues that can add to critical minutes, even hours to the timing of initiation and effectiveness of treatment in developing countries are delays in transportation.…”

A Single in Vivo Application of Cholinesterase Inhibitors Has Neuron Type-Specific Effects on Nicotinic Receptor Activity in Guinea Pig Hippocampus

“…Convulsions triggered by 1ϫ LD 50 soman became life-threatening when they occurred unremittingly and lasted longer than 10 min or when they recurred for longer than 10 min without the animals regaining consciousness during the interictus interval. There is evidence that 10 min of continuous convulsions is sufficient to damage neurons and that unremittingly or recurrent seizures lasting longer than 10 min are unlikely to self-terminate (DeLorenzo et al, 1999;García Peñ as et al, 2007). Thus, following the Institutional Animal Care and Use Committee guidelines, the animals were euthanized as soon as the life-threatening generalized unremittingly or recurrent convulsions developed.…”

What Should We Prescribe for Acute Seizures When There is No Intravenous Access?

“…While not trivial, the potential adverse events of benzodiazepines outweigh the danger of continued seizures and mainly include the risk of respiratory suppression/endotracheal intubation and hypotension in addition to less severe local reactions, for example, irritation due to intramuscular injection or effects on sinus mucosa with intranasal administration. Listing only a few potential adverse events may seem to some like sweeping the side effects of benzodiazepines under the carpet, but the risks need to be weighed against the risk of continuing seizures and status epilepticus, which we know carry ~30% risk of mortality if not rapidly controlled (9), and the risk of seizures extending into prolonged refractory status epilepticus, which has even higher rates of complications and death (10). Thus, for those patients who struggle with repetitive seizures and seizure flurries, there is a small light at the end of the long treatment tunnel-nonvenous medications other than rectal diazepam gel that are probably more efficacious and more socially acceptable.…”