Clinical Review

Status epilepticus: an evidence based guide

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7518.673 (Published 22 September 2005) Cite this as: BMJ 2005;331:673
  1. Matthew Walker, senior lecturer and honorary consultant neurologist (mwalker@doctors.org.uk)1
  1. 1 Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London WC1N 3BG

    Writing this article enabled Matthew Walker to revisit the few randomised controlled trials of status epilepticus. This confirmed how poor the data are and that there is little evidence to support one treatment regimen over another

    Introduction

    Status epilepticus is a prolonged seizure of any type. This article focuses mainly on the prolonged convulsion (convulsive status epilepticus) rather than non-convulsive status epilepticus.

    Though there is some debate about how long a convulsion has to last before being classified as status epilepticus, 30 minutes is generally accepted.1 Treatment should begin sooner, however, and a convulsion lasting longer than five minutes, or two convulsions without full recovery of consciousness in between, should usually receive emergency treatment.

    Who gets it?

    The incidence of status epilepticus is 10-60 per 100 000 person years, with the higher incidences occurring in poorer populations.25 Half of these patients have convulsive status epilepticus.

    Over half the patients with status epilepticus do not have a diagnosis of epilepsy, and often status epilepticus is precipitated by an acute illness. In children, the major cause of status epilepticus is infections accompanied by fever.3 In adults the main acute causes are:

    • Stroke

    • Hypoxia

    • Metabolic derangements

    • Alcohol intoxication or withdrawal (the most common cause in young adults)

    In people with a diagnosis of epilepsy, status epilepticus can be precipitated by drug withdrawal, due either to poor concordance or to a doctor stopping the drug.

    It is critical to remember that people with epilepsy may have an acute cause for their status epilepticus.

    How do I diagnose it?

    Diagnosing convulsive status epilepticus is generally straightforward, but it needs to be differentiated from pseudostatus epilepticus (non-epileptic attacks with a psychological basis). Non-epileptic attacks are often prolonged and can be confused with status epilepticus.

    In an audit of patients transferred to a specialist neurological intensive care unit for further treatment …

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