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For further information, see CMDT Part 24-03: Epilepsy

Key Features

Essentials of Diagnosis

  • Occurrence of two or more convulsions without recovery of consciousness between attacks

  • A fixed and enduring epileptic condition (for 30 minutes or more)

General Considerations

  • Status epilepticus is a medical emergency

  • Causes

    • Poor compliance with the anticonvulsant drug (most common)

    • Alcohol withdrawal

    • Intracranial infection or neoplasms

    • Metabolic disorders

    • Drug overdose

  • Mortality rate of convulsive status may be as high as 20%, with a high incidence of neurologic and mental sequelae

  • Prognosis relates to the length of time between onset of status epilepticus and start of effective treatment

Clinical Findings

Symptoms and Signs

  • Two clinical subtypes

    • Tonic-clonic convulsive status epilepticus

    • Nonconvulsive status epilepticus

  • Nonconvulsive status epilepticus is characterized by

    • Fluctuating abnormal mental status

    • Confusion

    • Impaired responsiveness

    • Automatism

    • Two subtypes: absence (petit mal) and complex partial status epilepticus

Differential Diagnosis

  • Seizure due to

    • Hypoglycemia

    • Electrolyte abnormality

    • Alcohol withdrawal

    • Cocaine

    • Bacterial meningitis

    • Herpes encephalitis

    • Brain tumor

    • CNS vasculitis

  • Syncope

  • Cardiac arrhythmia

  • Brainstem ischemia

  • Pseudoseizure

  • Panic attack

  • Rage attack

  • Migraine

  • Narcolepsy

Diagnosis

Laboratory Tests

  • Electroencephalography is essential in establishing the diagnosis of nonconvulsive status epilepticus and its two subtypes

Treatment

Medications

  • See Table 24–2

  • Initial treatment with intravenous lorazepam or midazolam is usually helpful regardless of the type of status epilepticus

  • Phenytoin, carbamazepine, and other drugs may also be needed to obtain and maintain control in complex partial status epilepticus

Table 24–2.Medication treatment for seizures in adults (in alphabetical order within classes).

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