Recognising and Responding to Life Threatening Emergencies

Status Epilepticus

Latest Course update : January 2019

Status Epilepticus is defined as prolonged epileptic activity (> 5 - 10 minutes) or frequent seizure activity with incomplete recovery between seizures. It is more common in children and may occur in patients with no previous history of seizures. Prolonged seizure activity has significant physiological effects on the body and may cause excess (cerebral) metabolic demands, nutrient depletion, hypoxia, lactic acidosis, hyperthermia and neuronal death resulting in irreversible cerebral injury. The period of seizure activity correlates with the degree of secondary brain injury and is independent of hypoxia and acidosis.

Visibly frightening, the patient with status epilepticus is at serious risk of physical injury, airway obstruction and hypoxia. Prolonged fitting may cause serious brain injury or death. Mortality rates between 3 - 20% are reported in the literature and depend on the presence of underlying structural lesions and the duration of the seizure. Urgent intervention is required to ensure a clear airway, correct hypoxia and control the seizure. In this topic we review the immediate management priorities in the patient with status epilepticus and the current options for pharmacological control of the seizure.

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