7 Things Everyone Needs to Know About Status Epilepticus

Emergency Plan
Wednesday, June 29, 2016
  1. Status Epilepticus is defined as a seizure lasting longer than 5 minutes, or two or more seizures happening without improvement in between.
    • The first definition is based on time. Older classifications defined status epilepticus as 10 or 20 minutes of continued seizure activity. More recently, many experts are using 5 minutes as the cutoff. The reason is that if a seizure lasts longer than 5 minutes, it may be time to call for extra help.
    • Status epilepticus also is defined as when more than one seizure occurs in a row, without the person improving between the seizures. This situation may actually happen more frequently than the first definition. It can be hard to tell if a person doesn’t come to between seizures because of ongoing seizure activity in the brain or if the brain is recovering from the first seizure. When recovery from a seizure takes longer than expected, it is possible that the seizure may be occurring electrically, with the only symptom being unconsciousness or confusion.
  2. Status Epilepticus is a true emergency.
    Prolonged seizures can be harmful. Many other body systems can be involved, especially if the seizure includes generalized tonic-clonic activity. Body metabolism can be altered, heart rhythms can change, and even breathing can be effected. The most important step in treating status is to recognize that it’s a true medical emergency.
  3. If a seizure lasts longer than 10 minutes it is not likely to stop on its own.
    Almost all seizures stop on their own. Most seizures last less than 2 or 3 minutes.  Although everyone is unique, studies have shown that if a seizure lasts longer than 10 minutes, medicines are usually needed to stop the seizure.
  4. If Status Epilepticus is treated earlier, it is easier to stop.
    Studies have shown that the sooner treatment of status epilepticus is started, the more likely the prolonged seizure will respond to medication. It’s been shown many times in the literature that changes in nerve cells in the brain occur with long seizures: the number of receptors on nerve cells decrease. When this happens, medications that act on these receptors will not work as well. This is another key reason to recognize status early.
  5. There is a well-defined treatment plan for Status Epilepticus.
    In 2016, the American Epilepsy Society published guidelines on the treatment of status epilepticus. These guidelines are based on the best available medical evidence in the literature. Although there have been similar published treatment protocols in the past, this new guideline incorporates some of the newer antiepileptic medications. This provides several options to treat status epilepticus.
  6. Not all Status Epilepticus is the same.
    Just as everyone’s seizures are unique, so is status epilepticus. There are multiple types of seizures. Although the guidelines referred to above are not specific for any seizure type, knowing what of seizure type you or your loved one has can be important. Certain medications may work better for certain types of seizure. If the treating provider knows what  type of seizure or epilepsy the person has, better decisions can be made with a more individualized approach to stop the status.
  7. Tell your doctor if you or your loved one with epilepsy has ever had Status Epilepticus, or if you are concerned that this may occur.
    Creating a plan to treat breakthrough seizures or cluster seizures is an important part of epilepsy management. Again, the treatment of epilepsy should be individualized for each person. Things to discuss could include when to call for emergency help, when to give a rescue medication, and how to stay safe if a seizure occurs.

Action Steps

Take these steps to prepare for a seizure emergency like Status Epilepticus:

  1. Know what type of seizures you have
  2. Tell your health care team if you’ve ever had status or cluster seizures or been hospitalized for long or repeated seizures.
  3. Update your seizure response plan each year or whenever you have a change in medicines.
  4. If you don’t have a seizure response plan, download a form from our Toolbox, fill out as much as you can, and take it to your next appointment with your epilepsy doctor or nurse.
  5. If you have a My Seizure Diary account, you can make one online and update it easily!
Authored by: Matthew Hoerth MD | Seizure Emergency Editor on 6/2016

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