National Epilepsy Day 2021: What Is Status Epilepticus? Causes, Symptoms, Diagnosis And Treatments

Every year on 17 November, National Epilepsy Day is celebrated to raise awareness about epilepsy and how to deal with 'seizures' associated with the condition. According to the Annals Of Indian Academy Of Neurology, India has more than 10 million individuals suffering from epilepsy and its prevalence is higher in rural areas compared to urban areas. [1]

Status epilepticus is one of the severe types of epilepsy and a medical emergency. In this article, we will discuss details on this condition. Take a look.

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What Is Status Epilepticus?

According to a definition by the American Epilepsy Society Working Group, status epilepticus is defined as a seizure lasting for more than 30 minutes or repetition of seizure for two or more times without enough recovery of consciousness between the attacks. [2]

Status epilepticus is a medical emergency as prolonged seizures can cause permanent nerve damage and serious metabolic decompensation (dehydration, anorexia, vomiting and lethargy), leading a person to coma and even death.

Most of the seizure types usually last for a minute or two and those that extend this time limit, such as status epilepticus, are unlikely to stop or difficult to control with antiepileptic drugs, thus increasing the risk of morbidity and mortality due to the condition.

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Types Of Status Epilepticus

Status epilepticus (SE) is broadly divided into two parts: convulsive status epilepticus and nonconvulsive status epilepticus.

1. Convulsive status epilepticus (CSE): It requires emergency treatment and can be life-threatening. CSE is of four categories: tonic-clonic SE (persists for 30 minutes or more); tonic SE (stiffness in the muscles); clonic SE (repetitive jerking movements of one of both body sides), and myoclonic SE (repeated of the jerks or seizures for a long time).
2. Nonconvulsive status epilepticus: It also lasts for at least 30 minutes and is characterised by abnormalities in eye movement, abnormal mental status, persistent electrographic seizures and unresponsiveness. It is easier to treat and may not cause significant neuronal damage. [3]

Causes Of Status Epilepticus

According to a study, status epilepticus commonly occurs in patients with a history of epilepsy. Around 34 per cent of cases of status epilepticus is due to low levels of anticonvulsant drugs, mainly due to its less than recommended dosing, recent medication change or non-compliance to prescribed medication course.

In people, without a history of epilepsy, the cause may vary significantly by age. For example, in adults, the primary cause of status epilepticus could be a tumour, stroke, alcohol withdrawal, meningoencephalitis and hypoxic-ischemic injury (brain injury due to oxygen deprivation). In children, the cause can be infection of the central nervous system, trauma and anoxic injury. [4]

Other causes may include hypoglycemia, cerebrovascular accidents, drug toxicity, internal head bleeding, autoimmune disorders and hypoxia.

Symptoms Of Status Epilepticus

Some of the symptoms of status epilepticus may include:

• Partial or complete loss of consciousness.
• Seizure of five minutes or more followed by recurrent seizure activity. [5]
• Tonic-clonic symptoms such as losing bowel control, severe headaches and sudden stiffness in the muscles of the arms and legs.
• Impaired mental status.
• Daydreaming look.
• Temporary paralysis.
• Visual changes.
• Smell or taste-related hallucinations.
• Feeling increased abdominal sensations.
• Effect on language skills.
• Repetitive lip-smacking or swallowing movements.

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Risk Factors Of Status Epilepticus

Some of the risk factors for status epilepticus are:

• Uncontrolled or poorly managed epilepsy.
• Brain injury
• Autoimmune disorder
• Drug abuse
• Infection
• Low blood glucose
• Heart, liver or kidney disease.

Complications Of Status Epilepticus

Patients with status epilepticus are prone to complications like: [6]

• Multiple organ failure.
• Multiple infections due to suppression of the immune system.
• Respiratory problems such as ventilator-associated pneumonia, pulmonary oedema and adult respiratory distress syndrome.
• Heart problems like arrhythmias and hypertension.
• Gastrointestinal bleeding
• Stress ulcer
• Kidney dysfunction.
• Urinary tract infection.

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Diagnosis Of Status Epilepticus

Diagnosing status epilepticus could be difficult as some symptoms like rigidity, shivering and tremor can be misinterpreted with other epilepsy types or other conditions such as meningitis or drug-induced coma. Some non-epileptic attacks which are for a prolonged period can also be confused with status epilepticus.

In many cases, electroencephalography (EEG) may help confirm the suspicion of status epilepticus in critically ill patients such as those in the ICU or in a coma. [7]

Treatments Of Status Epilepticus

• Experts say that patients with status epilepticus must be addressed quickly and also in an organised manner for effective treatment. [5]
• As soon as they are administered, their breathing and circulation must be managed along with administering antiepileptic drugs such as benzodiazepines.
• For pregnant women, a drug such as lorazepam is recommended.
• The focus of the treatment should be to reduce or cease seizure activity as soon as possible to prevent heart and respiratory problems that come with it.
• Supplemental oxygen and blood glucose are given if patients show decreased oxygen rate and hypoglycemia.
• If epileptic drugs do not work, the second dose of drugs intravenously is given.
• Surgery is suggested for patients with structural abnormality or hemispherectomy in which half of the brain is removed or disconnected.
• A neurologist is consulted for effective management of the condition.

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To Conclude

Status epilepticus is a life-threatening condition that needs to be managed as early as possible. It is also a complex neurologic condition that needs more research. Future research can help identify more treatment methods, therapies and effective drugs.