Status epilepticus

Status epilepticus is defined as epileptic activity that continues for more than 30 minutes as a single seizure or as recurrent seizures without inter-ictal return of consciousness. The seizure activity is usually classified as partial or generalized. Although status epilepticus is an uncommon admission diagnosis among patients admitted to a general ICU, a sound knowledge of the causes and treatment of this medical emergency is essential for prompt and effective management. Convulsive seizure activity causes marked systemic disturbances and neuronal injury proportional to the duration of seizure activity. Non-convulsive status should be suspected in patients with impaired consciousness without obvious cause and can only be definitely diagnosed with EEG monitoring. An intravenous bolus dose of a benzodiazepine (diazepam or lorazepam) should be used initially to terminate seizures. After this, an appropriate anti-epileptic agent (phenytoin) should be started and any systemic disturbances treated. Most episodes of status develop without a prior history of epilepsy. This fact is of major clinical relevance because the emergency management of all patients with status epilepticus must include a search for underlying causes. Patients with status epilepticus refractory to the above treatment measures should have general anaesthesia induced and maintained with infusions of an agent with GABA-ergic activity (thiopentone, propofol or midazolam), aiming for electro-encephalographic burst suppression for 24 hours in the first instance, but longer if necessary