Define Status Epilepticus. Describe its causes, management and complications.

Definition

• Status epilepticus is a continuous seizure lasting ≥ 5 minutes, or recurrent seizures without full recovery of consciousness between them.
• It is a neurological emergency with a risk of permanent brain injury and death.

Causes

• Prolonged febrile seizure; CNS infection (meningitis/encephalitis).
• Poor antiepileptic-drug adherence or withdrawal; metabolic (hypoglycaemia, hyponatraemia, hypocalcaemia).
• Acute brain injury (trauma, stroke, hypoxia); poisoning.

Stepwise Management

• ABC — airway, breathing, circulation; give oxygen; secure IV access; check blood glucose (treat hypoglycaemia).
• First-line (5 min): a benzodiazepine — IV lorazepam or IV/buccal/intranasal midazolam (may repeat once).
• Second-line (if continuing): IV phenytoin/fosphenytoin, levetiracetam or valproate.
• Refractory: anaesthetic agents (midazolam/thiopentone infusion) with intubation and ICU care.
• Treat the underlying cause throughout.

Complications

• Hypoxia, aspiration; hyperthermia and rhabdomyolysis.
• Cerebral injury; cardiovascular/metabolic derangements.

Principles of Drug Therapy

• Follow a time-based protocol — the longer a seizure continues, the harder it is to stop.
• Do not delay first-line benzodiazepine; prepare second-line and airway support early.

Causes to Always Exclude

• Hypoglycaemia (check glucose in every case) and electrolyte disturbances.
• CNS infection (meningitis/encephalitis); AED non-adherence; toxins/poisoning.

Complications of Prolonged Seizures

• Hypoxic brain injury, aspiration, hyperthermia and rhabdomyolysis.
• Cardiorespiratory compromise — hence the priority on airway, oxygen and prompt drug therapy.