What is status epilepticus?

Status epilepticus is said to occur when a seizure lasts too long or when seizures occur close together and the person doesn't recover between seizures. Just like there are different types of seizures, there are also different types of status epilepticus.

Over the last several decades, the length of seizure that is considered as status epilepticus has shortened. Years ago, a seizure needed to last longer than 20 minutes to be considered status epilepticus. In the last few years, it is now defined as any seizure greater than 5 minutes. This makes sense because most seizures do not last longer than 2 minutes. The longer a seizure lasts, the less likely it will stops on its own without medication. Very long seizures (i.e. statue epilepticus) are dangerous and even increase the chance of death. It is important that these long seizures are identified early, so they can be treated early.

Epilepsy.com Seizure Emergency Editor Matthew Hoerth MD speaks with Dr. Christopher Kramer, a neuroIntensive care specialist from the Mayo Clinic, about the importance of recognizing and treating status epilepticus. A paper published in the Neurocritical Care Journal from 2012 nicely outlined guidelines for treating this neurologic emergency. This paper detailed the subtypes of status epilepticus, emphasized the high mortality rates of this condition, and summarized the best medical evidence for treatment.

Convulsive Status Epilepticus

This term is used to describe the more common form of emergency situation that can occur with prolonged or repeated tonic-clonic (also called convulsive or grand mal) seizures. Most tonic-clonic seizures end normally in 1 to 2 minutes, but they may have post-ictal (or after-effects) symptoms for much longer. This makes it hard to tell when a seizure begins and ends.

Status epilepticus occurs when….

  • The active part of a tonic-clonic seizure lasts 5 minutes or longer
  • A person goes into a second seizure without recovering consciousness from the first one
  • If a person is having repeated seizures for 30 minutes or longer

This type of status epilepticus requires emergency treatment by trained medical personnel in a hospital setting. This situation can be life-threatening and getting treatment started fast is vital. The outlook for this type of status may vary depending on the cause of the emergency and if other medical problems or complications occur.

  • Status epilepticus requires urgent medical treatment to lessen the chance of serious complications.
  • Medical treatment needs to be started as soon as possible. Oxygen and other support for breathing, intravenous fluids (fluid given into a blood vessel), and emergency medications are needed.
  • At times, medicines called anesthetics are used in the hospital to put a person into a coma to stop the seizures.
  • Continuous EEG monitoring may be needed to monitor the seizures and how a person responds to treatment.
  • Tests may also be needed to find the cause of the seizure emergency so it can be treated correctly. People with a known cause, such as a brain infection, brain tumor or stroke, may have a worse outlook than those with no other medical problems or known cause.

Nonconvulsive Status Epilepticus

This term is used to describe long or repeated absence or complex partial seizures.

  • The person may be confused or not fully aware of what is going on, but they are not 'unconscious', like in a tonic clonic seizure.
  • These situations can be harder to recognize than convulsive seizures. Symptoms are more subtle and it's hard to tell seizure symptoms from the recovery period.
  • There is no consistent time-frame on when these seizures are called an emergency. It depends in part on how long a person's typical seizures are and how often they occur.

When nonconvulsive status epilepticus occurs or is suspected, emergency medical treatment in a hospital setting is needed. EEG testing may be needed to confirm the diagnosis first. People with this type of status are also at risk for convulsive status epilepticus, thus quick treatment is required.

Authored by: Steven C. Schachter, MD | Patricia O. Shafer, RN, MN | Joseph I. Sirven, MD on 8/2013
Reviewed by: Joseph I. Sirven, MD | Patricia O. Shafer, RN, MN on 3/2014
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