Status Epilepticus: An Overview of the Clinical Problem

Abstract

Summary: Status epilepticus has been recognized since antiquity. The terms état de mal and “status epilepticus” are derived from the slang used by epilepsy patients housed in Salpêtrière and Bicêtre hospitals in Paris during the 1800s. The definition of status epilepticus has been evolving, and is still not precise. In 1903–04 it was described as a development of epilepsy in which seizures are so frequent that “coma and exhaustion are continuous between seizures.” In 1964 the International League Against Epilepsy adopted the definition “a seizure [that] persists for a sufficient length of time or is repeated frequently enough to produce a fixed and enduring epileptic condition.” 30 min has been the most common specified duration of seizures for the diagnosis of status epilepticus, although a duration of 10 or 20 min has been suggested as well. However, a new set of definitions for generalized, convulsive status epilepticus in adults has been proposed and includes an operational definition (specifying a seizure duration of a least 5 min) and a mechanistic definition. In the future, laboratory tests will provide the means for detecting and defining the critical factors that distinguish a single epileptic seizure from status epilepticus. Recent epidemiological studies suggest status epilepticus occurs in 100,000 to 150,000 people in the US each year, and is associated with substantial morbidity and mortality. Etiology, duration of the seizures, and the patient's age seem to be important determinants of the outcome in status epilepticus.

Predictors and prognosis of refractory status epilepticus treated in a neurological intensive care unit

“…However, in most cases it is difficult to determine if such damage is related to the underlying pathology, to the status as such, or to a combination of both. [36][37][38] Experimental animal data indicate that symptomatic epilepsy in the wake of status is not necessarily associated with major structural lesions but may also result from plastic changes of the brain that may not be detected with current imaging modalities. 39 To our knowledge, the effects of NRSE and RSE on the development of symptomatic epilepsy have not yet been analysed.…”

Prevention or Modification of Epileptogenesis after Brain Insults: Experimental Approaches and Translational Research

“…SE is a common, serious, potentially life-threatening, neurologic emergency characterized by prolonged seizure activity (Lowenstein, 1999). Epidemiologic studies indicate that epilepsy develops in up to 43% of patients with SE (Hesdorffer et al, 1998).…”

Can Status Epilepticus Sometimes Just be a Long Seizure?

“…It cannot be assumed that this holds for other patient subgroups-such as those with acute provoked SE, with SE in the setting of baseline cognitive and neurological deficits, or with generalized or adult-onset epilepsies. It also does not mean that SE is not a dangerous event (8). These favorable outcomes reflect the timely interventions delivered by the excellent healthcare system of a Canadian province, and modern SE treatment with benzodiazepines and parenteral antiepileptic drugs (9).…”