Epileptic seizures (Epileptic fits, Status epilepticus)

What is Epileptic seizures?

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Status epilepticus is not a disease on itself. Rather, it is a clinical situation where there are recurrent seizure activities (fits) without periods of consciousness in between. Traditionally, to define status epilepticus the duration of recurrent seizures should be at least 30 minutes. This is a medical emergency that needs immediate treatment.Status epilepticus is a neurological clinical situation because of the recurrent seizures. It affects mainly the brain and also the organs innervated by the brain.

Statistics on Epileptic seizures?

This is a common condition, with an annual incidence of approximately 100,000 - 200,000 annually in the US.

Risk Factors for Epileptic seizures

Status epilepticus can happen across the age but is more common in people of a younger age and in the elderly. Being in the extremes of age is more likely to predispose someone to status epilepticus.Otherwise, there is no gender and racial predilection for developing status epilepticus.Other predisposing factors are dependent upon the potential triggers for status epilepticus, which is discussed in 'natural history'.

Progression of Epileptic seizures

Patients coming in with status epilepticus may have potential triggers that start off the recurrent seizures. Known triggers include:

Stopping or not taking antiepileptic drugs

Withdrawal syndromes, mainly due to discontinuation of alcohol, tranquilisers, and recreational drugs

Sudden brain injury, such as infection, cancer, stroke, trauma, and bleeding

Hereditary conditions such as cerebral palsy

Blood biochemical substance derangements including low glucose, high urea, vitamin deficiency, liver diseases or electrolyte abnormalities

Drug overdose

How is Epileptic seizures Diagnosed?

A patient with status epilepticus needs full physical examinations to find out potential cause of such event. These include looking at the blood function, kidney function, liver function, and the body's iron, vitamins and electrolytes level.

Prognosis of Epileptic seizures

The death rate of status epilepticus is high, where 20% of the cases lead to death. The cause of death is usually due to brain injury. The duration of the seizures has significant impact on the death rate. The figure increases from 3% initially to 32% after 60 minutes. Hence immediate treatment is needed in attempt to terminate the fitting. As would have been expected, the death rate is higher in children and elderly patients.

How is Epileptic seizures Treated?

Status epilepticus is treated as any medical emergency. The treatment principles are delineated as below:

Stop fitting

Resuscitation, including assessing the airway, breathing and circulation

Find the potential causes and manage them

To stop the seizure, sedatives (such as midazolam or diazepam) are commonly used. Midazolam can be given through injection into the muscle, while diazepam is better given through the veins. After the seizure is controlled, several antiepileptic agents can be used to maintain the seizure-free state. They include phenytoin and phenobarbitone.Resuscitation will include looking at the airway control, breathing status, and circulatory status and provide necessary support if needed.Treatment of the potential causes is important. They include antibiotic therapy for infections, etc. These will not be discussed here.

Epileptic seizures References

1. Chapman, MG, Smith, M, Hirsch, NP. Status epilepticus. Anaesthesia 2001; 56:6482. DeLorenzo, RJ, Pellock, JM, Towne, AR, Boggs, JG. Epidemiology of status epilepticus. J Clin Neurophysiol 1995; 12:3163. eMedicine: Status epilepticus [online]. 2005. [Cited 2005 October 27th]. Available from: URL: http://www.emedicine.com/EMERG/topic554.htm4. Hauser, WA. Status epilepticus: Epidemiologic considerations. Neurology 1990; 40(5 suppl 2):95. Shaner, DM, McCurdy, SA, Herring, MO, et al. Treatment of status epilepticus: A prospective comparison of diazepam and phenytoin versus phenobarbital and optional phenytoin. Neurology 1988; 38:202.6. Up to Date: Management of status epilepticus in adults [online]. 2005. [Cited 2005 October 27th]. Available from: URL: http://www.utdol.com/application/topic.asp?file=epilepsy/2440&type=A&selectedTitle=1~9