Expired CME Article

Status Epilepticus

Authors: Eliahu S. Feen, MD, Eric M. Bershad, MD, Jose I. Suarez, MD

Abstract

Status epilepticus (SE) in adults is a state of continuous seizures lasting more than 5 minutes, or rapidly recurrent seizures without regaining consciousness. The overall US and European estimated crude incidence rate of SE ranges from 6.8 to 41/100,000/yr. The etiologies of SE include primary central nervous system pathologies and systemic disorders. The two basic mechanisms involved in the genesis of SE are an excess of excitatory activity and a loss of normal inhibitory neurotransmission. Mortality associated with SE can be as high as 26% for the average adult. Early recognition and treatment are important for improving the chances for a good outcome. The first line of treatment is an intravenous benzodiazepine, with lorazepam being the current preferred agent. All patients with SE who remain with altered awareness 20 to 30 minutes after cessation of clinical seizures should undergo electroencephalographic studies, because up to 20% of patients without clinical evidence of seizures after initial treatment can have nonconvulsive SE.


Key Points


* Status epilepticus is defined as a state of continuous seizure activity lasting more than 5 minutes, or rapidly recurrent seizures without regaining consciousness.


* Seizures in status epilepticus can present in various forms, including generalized convulsive, generalized nonconvulsive, complex partial, and partial.


* Treatment of status epilepticus should be administered promptly after recognition. The earlier the treatment, the better the outcome.


* Optimal management of status epilepticus requires electroencephalographic monitoring.


* The first-line agent to use for treatment of status epilepticus is an intravenous benzodiazepine. Lorazepam is a preferred drug.

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