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status epilepticus

Status epilepticus is a continuous seizure state. It occurs when a person has a continuous epileptic seizure or one seizure followed by another without the person regaining consciousness. It can occur in all types of seizures.

What is going on in the body? 
Seizures are due to a temporary electrical disturbance in the brain. This can affect all areas of the brain or it can spread out from a single area. Status epilepticus occurs when the seizure continues for a long period of time. During this time, the person never regains consciousness. This type of prolonged seizure can result in death if it is not treated right away.

What are the signs and symptoms of the condition? 
Status epilepticus can be convulsive or non-convulsive. A person's symptoms can range from simply appearing dazed to the more serious muscle contractions, spasms, and loss of consciousness. The specific symptoms depend on the underlying type of seizure. The person may also have high blood pressure, rapid heartbeat, irregular heartbeats known as arrhythmias, and high blood sugar levels.

What are the causes and risks of the condition? 
Any condition that might causes structural damage to the brain can lead to status epilepticus. These include: Status epilepticus can occur at any age. However, it usually affects the very young and very old. It is a medical emergency which can be fatal unless it is treated right away.

What can be done to prevent the condition? 
A person who is taking medications to prevent seizures should take them as prescribed. If the level of medication in the bloodstream falls too low, status epilepticus may occur.

How is the condition diagnosed? 
The doctor can diagnose some attacks of status epilepticus by observing the person. This is especially true for generalised convulsive status epilepticus. Other cases are more difficult to diagnose, such as non-convulsive status epilepticus. A variety of laboratory and other special tests aid in the diagnosis.

Emergency treatment will continue while these tests are being done:
  • blood tests and drug screening tests to detect drug toxicity or withdrawal
  • arterial blood gases help determine acid-base imbalances and monitor the level of oxygen in the blood
  • cranial CT scan or cranial MRI to detect brain tumours or bleeding
  • electroencephalogram, or EEG, to measure changes in the electrical activity in the brain
What are the long-term effects of the condition? 
Status epilepticus can lead to permanent damage to the brain and heart, and to death.

What are the risks to others? 
There are no risks to others.

What are the treatments for the condition? 
Time is the critical issue. A person will be given emergency care while the cause of the seizure is being determined. Emergency care includes:
  • giving oxygen
  • starting an intravenous line to inject medications
  • using short-acting, muscle paralysing medications to stop the seizures
  • giving medication to control seizures
  • keeping the person from injury
What are the side effects of the treatments? 
Side effects of treatment depend on the medications given. Anti-epileptic medication may cause drowsiness in some people and hyperactivity in others.

What happens after treatment for the condition? 
After emergency treatment, a person will need to take any daily seizure medications exactly as prescribed.

How is the condition monitored? 
A person will need follow-up visits to the doctor to make sure that the level of medication in the bloodstream is appropriate. The dose may need to be adjusted. The person should wear a MedicAlert bracelet that indicates he or she has epilepsy.

Author: Eric Berlin, MD
Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne
Last Updated: 7/03/2005
Potential conflict of interest information for reviewers available on request

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