Status epilepticus

The usual definition of status epilepticus involves continuous or recurrent seizure activity without recovery, typically with a minimum duration of 30 min. However, this duration is arbitrary and, while important for epidemiological studies, is not useful at the bedside. The average duration of monitored single seizures is about 1 min, and since most seizures end spontaneously within 4 min, one should consider treatment for status epilepticus after about 5 min.

Status epilepticus is easily diagnosed when the patient suffers prolonged convulsions or has numerous partial seizures without an intervening recovery of normal alertness. More challenge arises when status epilepticus occurs without obvious motor manifestations, particularly if the patient has other reasons for unresponsiveness. In such circumstances, careful observation for small clonic movements (e.g. twitches of the corner of the eye) may be very rewarding. Other neurological symptoms such as aphasia may be signs of status epilepticus. The need for an EEG in this circumstance is indisputable. About 20 per cent of status epilepticus is non-convulsive. The EEG appearance of different forms and durations of status epilepticus is quite variable.

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