Consultation with the Specialist
Status Epilepticus
Margaret C. McBride 1
1 Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY.
Status epilepticus has been defined as continuous seizure activity or intermittent seizure activity without recovery of consciousness between seizures that lasts for more than 30 minutes. However, if a seizure has continued unabated for 5 minutes, status epilepticus should be presumed and therapy initiated. Status epilepticus is a medical emergency, and all primary care physicians should know how to initiate its treatment.
Usually status epilepticus consists of generalized or asymmetric clonic activity with unconsciousness. However, prolonged absence or partial seizures comprise 10% of episodes. Absence status epilepticus usually occurs in children who have severe primary generalized epilepsy or Lennox-Gastaut syndrome. Partial status epilepticus occurs in children who have focal brain pathology. The initial treatment of both is like that for generalized status epilepticus, with only slightly less urgency. The remainder of this review concerns generalized status epilepticus.
Etiology
It is important to obtain both remote and recent histories from the child's family or attendant as soon as possible so that an appropriate differential diagnosis may be developed. In 25% of cases, status is idiopathic. In another 25% it is provoked only by fever (febrile status). In the 20% of children who have a static encephalopathy, the condition is termed remote symptomatic status epilepticus. In another 20%, status is termed acute symptomatic and is an expression of an acute encephalopathy or brain injury.
