Status epilepticus: Difference between revisions
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'''Status epilepticus''' is "prolonged [[seizure]] or seizures repeated frequently enough to prevent recovery between episodes occurring over a period of 20-30 minutes. The most common subtype is generalized tonic-clonic status epilepticus, a potentially fatal condition associated with neuronal injury and respiratory and metabolic dysfunction. Nonconvulsive forms include petit mal status and complex partial status, which may manifest as behavioral disturbances. Simple partial status epilepticus consists of persistent motor, sensory, or autonomic seizures that do not impair cognition (see also epilepsia partialis continua). Subclinical status epilepticus generally refers to seizures occurring in an unresponsive or comatose individual in the absence of overt signs of seizure activity."<ref name="MeSH-status">{{MeSH}}</ref> | '''Status epilepticus''' is "prolonged [[seizure]] or seizures repeated frequently enough to prevent recovery between episodes occurring over a period of 20-30 minutes. The most common subtype is generalized tonic-clonic status epilepticus, a potentially fatal condition associated with neuronal injury and respiratory and metabolic dysfunction. Nonconvulsive forms include petit mal status and complex partial status, which may manifest as behavioral disturbances. Simple partial status epilepticus consists of persistent motor, sensory, or autonomic seizures that do not impair cognition (see also epilepsia partialis continua). Subclinical status epilepticus generally refers to seizures occurring in an unresponsive or comatose individual in the absence of overt signs of seizure activity."<ref name="MeSH-status">{{MeSH}}</ref> | ||
==Epidemiology== | |||
One study found that 2 of 25 patients in the emergency room with mental status changes without obvious cause had nonconvulsive status epilepticus.<ref name="pmid17277572">{{cite journal |author=Bautista RE, Godwin S, Caro D |title=Incorporating abbreviated EEGs in the initial workup of patients who present to the emergency room with mental status changes of unknown etiology |journal=J Clin Neurophysiol |volume=24 |issue=1 |pages=16–21 |year=2007 |pmid=17277572 |doi=10.1097/WNP.0b013e318030e8cb}}</ref> One third of elderly patients with nonconvulsive status have a history of epilepsy.<ref name="pmid17381437">{{cite journal |author=Bottaro FJ, Martinez OA, Pardal MM, Bruetman JE, Reisin RC |title=Nonconvulsive status epilepticus in the elderly: a case-control study |journal=Epilepsia |volume=48 |issue=5 |pages=966–72 |year=2007 |pmid=17381437 |doi=10.1111/j.1528-1167.2007.01033.x}}</ref> | |||
==Classification== | ==Classification== | ||
===Generalized status epilepticus=== | Status epilepticus may be classified by either the type of seizure or the time course. | ||
===Type of seizure=== | |||
====Generalized status epilepticus==== | |||
===Nonconvulsive status epilepticus=== | ====Nonconvulsive status epilepticus==== | ||
Nonconvulsive status epilepticus is an important cause of acute confusion or altered mental status.<ref name="pmid17684419">{{cite journal |author=Beyenburg S, Elger CE, Reuber M |title=Acute Confusion or Altered Mental State: Consider Nonconvulsive Status Epilepticus |journal=Gerontology |volume=53 |issue=6 |pages=150–158 |year=2007 |pmid=17684419 |doi=10.1159/000106829}}</ref> | Nonconvulsive status epilepticus is an important cause of acute confusion or altered mental status.<ref name="pmid17684419">{{cite journal |author=Beyenburg S, Elger CE, Reuber M |title=Acute Confusion or Altered Mental State: Consider Nonconvulsive Status Epilepticus |journal=Gerontology |volume=53 |issue=6 |pages=150–158 |year=2007 |pmid=17684419 |doi=10.1159/000106829}}</ref> | ||
;Petit mal status | ;Petit mal status | ||
| Line 15: | Line 20: | ||
;Subclinical status epilepticus | ;Subclinical status epilepticus | ||
In subclinical status epilepticus the patient may be unresponsive or comatose and without overt signs of seizures.<ref name="MeSH-status"/> | In subclinical status epilepticus the patient may be unresponsive or comatose and without overt signs of seizures.<ref name="MeSH-status"/> | ||
===Time course=== | |||
Below is a classification based on the time course of the seizure(s).<ref name="pmid16235337">{{cite journal |author=Prasad K, Al-Roomi K, Krishnan PR, Sequeira R |title=Anticonvulsant therapy for status epilepticus |journal=Cochrane Database Syst Rev |volume= |issue=4 |pages=CD003723 |year=2005 |pmid=16235337 |doi=10.1002/14651858.CD003723.pub2}}</ref> | |||
====Premonitory phase==== | |||
Premonitory phase is the "period during which seizures became increasingly frequent or severe but the condition did not meet the definition of status epilepticus."<ref name="pmid16235337"/> | |||
====Early status epilepticus==== | |||
Early status is the "first 30 minutes of seizure activity."<ref name="pmid16235337"/> | |||
====Established status epilepticus==== | |||
Established status epilepticus is a "condition with either more than 30 minutes of continuous seizure activity or two or more sequential seizures without recovery of full consciousness between the seizures".<ref name="pmid16235337"/> | |||
====Refractory status epilepticus==== | |||
If seizure activity remains uncontrolled for one to two hours, in spite of first-line treatment, then the participant is considered to be in refractory status epilepticus | |||
==Diagnosis== | ==Diagnosis== | ||
The patients may only show atypical triphasic waves on their electroencephalogram.<ref name="pmid17942373">{{cite journal |author=Kaya D, Bingol CA |title=Significance of atypical triphasic waves for diagnosing nonconvulsive status epilepticus |journal=Epilepsy Behav |volume=11 |issue=4 |pages=567–77 |year=2007 |pmid=17942373 |doi=10.1016/j.yebeh.2007.07.014}}</ref> | The patients may only show atypical triphasic waves on their electroencephalogram.<ref name="pmid17942373">{{cite journal |author=Kaya D, Bingol CA |title=Significance of atypical triphasic waves for diagnosing nonconvulsive status epilepticus |journal=Epilepsy Behav |volume=11 |issue=4 |pages=567–77 |year=2007 |pmid=17942373 |doi=10.1016/j.yebeh.2007.07.014}}</ref> | ||
== | ==Treatment== | ||
"Lorazepam is better than diazepam or phenytoin alone for cessation of seizures" according to a [[meta-analysis]] of [[randomized controlled trial]]s by the [[Cochrane Collaboration]].<ref name="pmid16235337">{{cite journal |author=Prasad K, Al-Roomi K, Krishnan PR, Sequeira R |title=Anticonvulsant therapy for status epilepticus |journal=Cochrane Database Syst Rev |volume= |issue=4 |pages=CD003723 |year=2005 |pmid=16235337 |doi=10.1002/14651858.CD003723.pub2}}</ref> | |||
==References== | ==References== | ||
Revision as of 23:47, 29 January 2008
Status epilepticus is "prolonged seizure or seizures repeated frequently enough to prevent recovery between episodes occurring over a period of 20-30 minutes. The most common subtype is generalized tonic-clonic status epilepticus, a potentially fatal condition associated with neuronal injury and respiratory and metabolic dysfunction. Nonconvulsive forms include petit mal status and complex partial status, which may manifest as behavioral disturbances. Simple partial status epilepticus consists of persistent motor, sensory, or autonomic seizures that do not impair cognition (see also epilepsia partialis continua). Subclinical status epilepticus generally refers to seizures occurring in an unresponsive or comatose individual in the absence of overt signs of seizure activity."[1]
Epidemiology
One study found that 2 of 25 patients in the emergency room with mental status changes without obvious cause had nonconvulsive status epilepticus.[2] One third of elderly patients with nonconvulsive status have a history of epilepsy.[3]
Classification
Status epilepticus may be classified by either the type of seizure or the time course.
Type of seizure
Generalized status epilepticus
Nonconvulsive status epilepticus
Nonconvulsive status epilepticus is an important cause of acute confusion or altered mental status.[4]
- Petit mal status
Petit mal status may cause behavioral disturbances.
- Complex partial status
Complex partial status may cause behavioral disturbances.
- Simple partial status
Simple partial status (Epilepsia partialis continua) does not impair cognition.
- Subclinical status epilepticus
In subclinical status epilepticus the patient may be unresponsive or comatose and without overt signs of seizures.[1]
Time course
Below is a classification based on the time course of the seizure(s).[5]
Premonitory phase
Premonitory phase is the "period during which seizures became increasingly frequent or severe but the condition did not meet the definition of status epilepticus."[5]
Early status epilepticus
Early status is the "first 30 minutes of seizure activity."[5]
Established status epilepticus
Established status epilepticus is a "condition with either more than 30 minutes of continuous seizure activity or two or more sequential seizures without recovery of full consciousness between the seizures".[5]
Refractory status epilepticus
If seizure activity remains uncontrolled for one to two hours, in spite of first-line treatment, then the participant is considered to be in refractory status epilepticus
Diagnosis
The patients may only show atypical triphasic waves on their electroencephalogram.[6]
Treatment
"Lorazepam is better than diazepam or phenytoin alone for cessation of seizures" according to a meta-analysis of randomized controlled trials by the Cochrane Collaboration.[5]
References
- ↑ 1.0 1.1 Anonymous (2024), Status epilepticus (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Bautista RE, Godwin S, Caro D (2007). "Incorporating abbreviated EEGs in the initial workup of patients who present to the emergency room with mental status changes of unknown etiology". J Clin Neurophysiol 24 (1): 16–21. DOI:10.1097/WNP.0b013e318030e8cb. PMID 17277572. Research Blogging.
- ↑ Bottaro FJ, Martinez OA, Pardal MM, Bruetman JE, Reisin RC (2007). "Nonconvulsive status epilepticus in the elderly: a case-control study". Epilepsia 48 (5): 966–72. DOI:10.1111/j.1528-1167.2007.01033.x. PMID 17381437. Research Blogging.
- ↑ Beyenburg S, Elger CE, Reuber M (2007). "Acute Confusion or Altered Mental State: Consider Nonconvulsive Status Epilepticus". Gerontology 53 (6): 150–158. DOI:10.1159/000106829. PMID 17684419. Research Blogging.
- ↑ 5.0 5.1 5.2 5.3 5.4 Prasad K, Al-Roomi K, Krishnan PR, Sequeira R (2005). "Anticonvulsant therapy for status epilepticus". Cochrane Database Syst Rev (4): CD003723. DOI:10.1002/14651858.CD003723.pub2. PMID 16235337. Research Blogging.
- ↑ Kaya D, Bingol CA (2007). "Significance of atypical triphasic waves for diagnosing nonconvulsive status epilepticus". Epilepsy Behav 11 (4): 567–77. DOI:10.1016/j.yebeh.2007.07.014. PMID 17942373. Research Blogging.