Approach to managing acute seizures and status epilepticus
Most seizures are brief and end within 1 to 3 minutes without drug treatment. Acute symptomatic seizures are caused by a transient systemic or central nervous system insult. Epilepsy is a disorder characterised by a tendency to experience recurrent seizures.
Status epilepticus refers to continuous seizure activity or repeated seizures without full recovery of consciousness between attacks. The minimum duration of continuous seizure activity required for the diagnosis of status epilepticus is traditionally agreed to be 30 minutes. However, drug treatment for a seizure should start after 5 minutes of continuous seizure activity.
Status epilepticus may be convulsive or nonconvulsive. The seizures of convulsive status epilepticus are usually tonic-clonic but may be tonic and, after treatment, may become clinically subtle. Nonconvulsive status epilepticus may be generalised (absence status epilepticus) or focal (partial) (impaired awareness [complex partial] or aware [simple partial] status epilepticus).
The treatment of nonconvulsive status epilepticus is less urgent and the risks of therapy, particularly respiratory depression, must be weighed against the risks of continuing nonconvulsive seizures.
The goals of managing status epilepticus are to:
- resuscitate the patient
- stop the seizures
- diagnose the cause of the seizures and treat it when possible
- find and treat complications of the seizures.
Factors that influence management include:
- type of seizure and its setting
- patient's age
- history of seizures and drugs taken for them (including concordance with therapy)
- treatment already administered for this episode.