A life-threatening neurologic condition defined as 5 or more minutes of either continuous seizure activity or repetitive seizures without regaining consciousness.
Generalized convulsive status epilepticus (SE) in both its subtle and overt subtypes constitutes the most frequent variant.
Diagnosis of nonconvulsive SE can be difficult, but recognition is crucial because rapid termination helps prevent serious brain injury, especially in patients with impaired consciousness.
In most cases, treatment must precede any thorough investigation and must be initiated as soon as SE is suspected.
Treatment involves a stepwise medication approach aimed at aborting the clinical and electrographic seizures.
Carries a high mortality rate and may cause serious complications if not promptly treated.
Generalized convulsive and nonconvulsive status epilepticus (SE) are neurologic and medical emergencies defined as 5 or more minutes of either continuous seizure activity or repetitive seizures with no intervening recovery of consciousness. Traditionally SE was defined as 30 or more minutes; however, this time frame has been reduced to 5 minutes to emphasize the seriousness of the condition and the need to treat it urgently.
In the 2017 International League Against Epilepsy (ILAE) classification of seizures paper, convulsive seizures are termed "focal to bilateral tonic-clonic" seizures if they are focal in onset, and "generalized tonic-clonic" if they are generalized in onset. As the time of onset of a seizure may be unknown when a patient presents to medical attention in SE and as both types of convulsive SE are treated identically, for the purposes of this topic, the categories "generalized convulsive SE" and "nonconvulsive SE" will be used.
History and exam
Assistant Professor of Neurology
Johns Hopkins Medical Institutions
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Dr Emily L. Johnson would like to gratefully acknowledge Dr Ronald P. Lesser, Dr Mohammad Koubeissi, and Dr Nabil Azar, previous contributors to this topic.
RPL or his wife have stock in the following companies, which sell health care products: Abbott Labs, Apple, Avanos, Celgene, Express Scripts, Johnson and Johnson, and Pfizer. NJA declares that he has no competing interests. MZK declares that he has no competing interests.
John Radcliffe Hospital
YH has been reimbursed by UCB Pharma Ltd, Janssen-Cilag Ltd, Pfizer Ltd, and Eisai Ltd for attending conferences; has taught at meetings sponsored by the above companies and by GlaxoSmithKline Services Unlimited; and has received payment for advisory board work from UCB Pharma Ltd, Janssen-Cilag Ltd, Eisai Ltd, and GlaxoSmithKline Services Unlimited.
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