Status Epilepticus

Posted by e-Medical PPT
Status epilepticus is a life-threatening condition in which the brain is in a state of persistent seizure.It is defined as one continuous unremitting seizure lasting longer than 30 minutes, or recurrent seizures without regaining consciousness between seizures for greater than 30 minutes.It is always considered a medical emergency. There is some evidence that 5 minutes is sufficient to damage neurons and that seizures are unlikely to self-terminate by that time. First aid guidelines for seizures state that, as a rule, an ambulance should be called for seizures lasting longer than 5 minutes (if this is the patient's first seizure episode and there were no known precipitating factors, or if SE happens to an epileptic whose seizures were previously absent or well-controlled for a considerable time period, then that step can be taken before that point).The mortality rate of status epilepticus is very high (at least 20%), especially if treatment is not initiated quickly. However, with optimal neurological care and a good prognosis, the patient in otherwise good health can survive with minimal or no brain damage, and can even avoid future seizures.
Status epilepticus can be divided into two categories—convulsive and nonconvulsive, the latter of which is underdiagnosed.

Convulsive
Epilepsia partialis continua is a variant involving hour, day, or even week-long jerking. It is a consequence of vascular disease, tumours, or encephalitis, and is drug-resistant.
Generalized myoclonus is commonly seen in comatose patients following CPR and is seen by some as an indication of catastrophic damage to the neocortex.

Nonconvulsive
Complex partial status epilepticus, or CPSE, and absence status epilepticus are rare forms of the condition which are marked by nonconvulsive seizures. In the case of CPSE, the seizure is confined to a small area of the brain, normally the temporal lobe. But the latter, absence status epilepticus, is marked by a generalised seizure affecting the whole brain, and an EEG is needed to differentiate between the two conditions. This results in episodes characterized by a long-lasting stupor, staring and unresponsiveness.


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