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Convulsive Status Epilepticus

Generalized convulsive state lasting more than 5 minutes or with no return of consciousness between two seizures is a time-critical emergency.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Acil Servis department. Book Appointment →

What is Convulsive Status Epilepticus?

Status epilepticus (SE) is defined as continuous seizure lasting more than 5 minutes or recurrent seizures without recovery of consciousness between them. The convulsive form is the most commonly encountered form.

The treatment algorithm is stepwise: first-line benzodiazepine (IV lorazepam 0.1 mg/kg or IM midazolam), second-line levetiracetam or fosphenytoin, refractory SE requires intensive care with anesthesia.

Treatment delay increases the risk of neuronal damage, mortality and refractory SE. The underlying cause (infection, metabolic, trauma, drug) must be investigated.

Symptoms

Continuous generalized tonic-clonic seizure
Loss of consciousness
Jaw locking and tongue biting
Urinary or fecal incontinence
Cyanosis and respiratory difficulty
Postictal confusion
Hyperpyrexia, acidosis

Risk Factors

Known epilepsy and treatment non-compliance
Central nervous system infection
Stroke and brain tumor
Head trauma
Metabolic disorder (hypoglycemia, hyponatremia, uremia)
Drug intoxication or withdrawal
Alcohol withdrawal

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Seizure lasting more than 5 minutes should be evaluated by 112 immediately
  • If consciousness does not return between two seizures, accept as SE
  • Go to emergency in postictal confusion that does not return to normal
  • If clustering occurs in known epilepsy patient, treatment should be adjusted

Treatment Methods

01
Airway, breathing, circulation (ABC) safety
02
Blood sugar, electrolyte and toxic screening
03
First line: IV lorazepam 0.1 mg/kg or IM midazolam
04
Second line: levetiracetam 60 mg/kg or fosphenytoin 20 mg/kg
05
Refractory SE: propofol, midazolam or pentobarbital infusion and mechanical ventilation
06
Continuous EEG monitoring
07
Investigation and treatment of underlying cause

Which Department to Visit?

You can visit our Acil Servis department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.