There is no specific data as to why Status Epilepticus attacks an individual. It occurs in both those with a history of epilepsy and those without any history. In cases of those with epilepsy, the reason could be due to the underlying problem in the brain. Additional causes include infections, strokes, tumor, and trauma.
What is Status Epilepticus?
Status epilepticus is an epileptic seizure that lasts for more than 5 minutes or can produce 2 or more seizure attacks within the specified 5 minute period. Previous definitions defined Status Epilepticus with a time limit of 30 minutes or more. The seizures are similar to that of tonic-clonic format, which displays the pattern of contraction in the legs and arms. It can also show symptoms that do not involve contractions like absence seizures. Status Epilepticus can turn into a life threatening attack if there is a delay in treatment.
Diagnosing Status Epilepticus involves imaging the head, checking the blood sugar levels, performing a number of blood tests, and electroencephalogram. Other conditions that provide information about the presence of status epilepticus is low blood sugar, delirium, movement disorders, and meningitis. It is also feasible for the presence of psychogenic nonepileptic seizures.
Types of Status Epilepticus
- Convulsive Status Epilepticus: In Convulsive Status Epilepticus, the individual displays contraction and extension of both legs and arms. Epilepsia Partialis Continua is one among the different variants that can involve minutes, hours, days, or weeks of jerking movement. The occurrence is due to brain tumor, vascular disease, and encephalitis. All these are drug resistant.
- Nonconvulsive Status Epilepticus: Nonconvulsive Status Epilepticus occurs without an aggressive extension of the limbs because of this seizure activity. Additionally, it also shows a long duration in person’s consciousness level. It can occur as absence seizure or complex partial seizures. Complex partial seizure attacks only a specific or a small portion of the brain. In absence seizure, the person suffers from generalized seizure attack that affects the entire brain.
How is Status Epilepticus Treated?
Benzodiazepines are the first preferred medication to treat Status Epilepticus. According to the first aid guidelines, it is essential to call the emergency services immediately if this seizure lasts more than 5 minutes.
When given through IV, lorazepam acts as a superior treatment to diazepam, which helps end the seizure attack. Using midazolam as an intramuscular medication is of immense help and the best option available for those who are not in a hospital.
In case of absence of both lorazepam and IV, it is preferable to opt for diazepam as a solution. Outside North America, intravenous clonazepam is the first choice of drug that most choose to provide relief to the individual who is undergoing the Status Epilepticus attack. For instance, Netherlands recommends the use of clonazepam because of the advantages it offers. When induced into the individual, the effect remains for a longer duration when compared with that of diazepam.
Phenytoin and Fosphenytoin
Phenytoin is another drug that is helpful in treating Status Epilepticus. If the doctor decides to use the medication or any other hydantoin derivative, then it is essential to monitor the activity of the heart continuously. The reason is that hydantoins take about 30 minutes to begin working and bring down the seizure attack in the individual. As diazepam works for a short duration of time, the doctor administers both diazepam and phenytoin through IV to the patient.
Carbamazepine and Valproate
Valproate is helpful in treating Status Epilepticus and is available as an intravenous formula. Carbamazepine is not available as an intravenous formula, and therefore it has no significant role to play in Status Epilepticus.
“Status Epilepticus” – Epilepsy Foundation Website: https://www.epilepsy.com/learn/about-epilepsy-basics/what-happens-during-seizure/status-epilepticus
“Status Epilepticus: A Review” – National Center for Biotechnology Information Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101959/
“Status Epilepticus: An Overview” – Cleveland Clinic Article: https://my.clevelandclinic.org/health/diseases/9832-status-epilepticus
“Treatment of Convulsive Status Epilepticus” – American Epilepsy Society Guidelines: https://www.aesnet.org/sites/default/files/file_attach/convulsivestatusfinal.pdf
“Management of Status Epilepticus” – UpToDate Article: https://www.uptodate.com/contents/management-of-status-epilepticus-in-adults