Status epilepticus is a medical and neurologic emergency that requires prompt assessment and and treatment. It may manifest in different clinical syndromes with distinctive clinical features and electroencephalography (EEG) findings. Status epilepticus has been historically defined by the International League Against Epilepsy (ILAE) and others as a single epileptic seizure lasting for >30 minutes duration or a series of epileptic seizures during which function is not regained between ictal events in a 30-minute period. However, this definition is not practical or appropriate as treatment should start without delay if seizure continued for more than few minutes to avoid cardiovascular morbidity and refractory status with worse neurological outcome.
An accepted operational definition of status epilepticus consists of seizure activity lasting ≥5 minutes of continuous seizures, or ≥2 discrete seizures between which there is incomplete recovery of consciousness. The 5-minute definition is used to minimize both the risk of seizures reaching 30 minutes and the adverse outcomes associated with needlessly intervening on brief, self-limited seizures [1].
The above infographic gives a stepwise approach to the management of status epilepticus in adults of more than 40 Kg of weight based on the most recent evidence [2-3].
REFERENCES
1. Lowenstein DH, Bleck T, Macdonald RL. It's time to revise the definition of status epilepticus. Epilepsia. 1999 Jan;40(1):120-2. doi: 10.1111/j.1528-1157.1999.tb02000.x. PMID: 9924914.
2. Chen JW, Wasterlain CG. Status epilepticus: pathophysiology and management in adults. Lancet Neurol. 2006 Mar;5(3):246-56. doi: 10.1016/S1474-4422(06)70374-X. PMID: 16488380.
3. Glauser T, Shinnar S, Gloss D, et al. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016;16(1):48-61. doi:10.5698/1535-7597-16.1.48