Overview
Clinical Meaning
Status epilepticus (SE) is defined as continuous seizure activity lasting 5 minutes or two or more seizures without full recovery of consciousness between episodes.
Status epilepticus (SE) is defined as continuous seizure activity lasting > 5 minutes or two or more seizures without full recovery of consciousness between episodes. It is a medical emergency with mortality rates of 15-20%. Prolonged seizure activity causes excitotoxic neuronal injury through excessive glutamate release, calcium influx, and mitochondrial dysfunction. GABA receptor internalization occurs after 5-30 minutes, making benzodiazepines less effective with delayed treatment. Systemic complications include hyperthermia, rhabdomyolysis, metabolic acidosis, aspiration, cardiac arrhythmias, and respiratory failure. The most common cause in known epilepsy patients is anticonvulsant non-compliance or subtherapeutic drug levels. Other causes include CNS infection, stroke, metabolic derangements (hypoglycemia, hyponatremia), drug toxicity, and alcohol withdrawal. Treatment follows a staged protocol: first-line benzodiazepines, second-line IV antiepileptics, and third-line anesthetic agents if refractory.