Status epilepticus: Difference between revisions
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*Following are the conditions that could lead to a status epilepticus: | *Following are the conditions that could lead to a status epilepticus: | ||
**[[Epilepsy]]: Approximately twenty-five percent of patients with status epilepticus have [[epilepsy]].<ref name="StasiukynienėPilvinis2009">{{cite journal|last1=Stasiukynienė|first1=Virginija|last2=Pilvinis|first2=Vidas|last3=Reingardienė|first3=Dagmara|last4=Janauskaitė|first4=Liuda|title=Epileptic seizures in critically ill patients|journal=Medicina|volume=45|issue=6|year=2009|pages=501|issn=1010-660X|doi=10.3390/medicina45060066}}</ref> | **[[Epilepsy]]: Approximately twenty-five percent of patients with status epilepticus have [[epilepsy]].<ref name="StasiukynienėPilvinis2009">{{cite journal|last1=Stasiukynienė|first1=Virginija|last2=Pilvinis|first2=Vidas|last3=Reingardienė|first3=Dagmara|last4=Janauskaitė|first4=Liuda|title=Epileptic seizures in critically ill patients|journal=Medicina|volume=45|issue=6|year=2009|pages=501|issn=1010-660X|doi=10.3390/medicina45060066}}</ref> | ||
**Stroke<ref name="StasiukynienėPilvinis2009">{{cite journal|last1=Stasiukynienė|first1=Virginija|last2=Pilvinis|first2=Vidas|last3=Reingardienė|first3=Dagmara|last4=Janauskaitė|first4=Liuda|title=Epileptic seizures in critically ill patients|journal=Medicina|volume=45|issue=6|year=2009|pages=501|issn=1010-660X|doi=10.3390/medicina45060066}}</ref> | |||
**Infections: | **Infections: | ||
***CNS: [[Meningitis]], [[encephalitis]] or brain [[abscess]] | ***CNS: [[Meningitis]], [[encephalitis]] or brain [[abscess]] | ||
** | ***Other infections leading to high fever, especially in children | ||
**Metabolic abnormalities: This could be a result of underlying [[renal]] or [[hepatic]] pathology causing [[hyponatremia]], [[hypoglycemia]] or [[hypocalcemia]]. | |||
**[[Cerebral]] trauma or [[cerebrovascular accidents]] due to [[hypertensive]] crisis.<ref name="LangenbruchKrämer2019">{{cite journal|last1=Langenbruch|first1=Lisa|last2=Krämer|first2=Julia|last3=Güler|first3=Sati|last4=Möddel|first4=Gabriel|last5=Geßner|first5=Sophia|last6=Melzer|first6=Nico|last7=Elger|first7=Christian E.|last8=Wiendl|first8=Heinz|last9=Budde|first9=Thomas|last10=Meuth|first10=Sven G.|last11=Kovac|first11=Stjepana|title=Seizures and epilepsy in multiple sclerosis: epidemiology and prognosis in a large tertiary referral center|journal=Journal of Neurology|volume=266|issue=7|year=2019|pages=1789–1795|issn=0340-5354|doi=10.1007/s00415-019-09332-x}}</ref> | |||
**Alteration in [[anticonvulsive]] therapy including but not limited to sudden withdrawal or sub-optimal dosing, concomitant alcohol consumption, inadequate nutrition, starting a new medication that is non-compatible with anticonvulsive drugs and/or drug resistance. | |||
**[[Hypoxia]]<ref name="LangenbruchKrämer2019">{{cite journal|last1=Langenbruch|first1=Lisa|last2=Krämer|first2=Julia|last3=Güler|first3=Sati|last4=Möddel|first4=Gabriel|last5=Geßner|first5=Sophia|last6=Melzer|first6=Nico|last7=Elger|first7=Christian E.|last8=Wiendl|first8=Heinz|last9=Budde|first9=Thomas|last10=Meuth|first10=Sven G.|last11=Kovac|first11=Stjepana|title=Seizures and epilepsy in multiple sclerosis: epidemiology and prognosis in a large tertiary referral center|journal=Journal of Neurology|volume=266|issue=7|year=2019|pages=1789–1795|issn=0340-5354|doi=10.1007/s00415-019-09332-x}}</ref> | |||
Metabolic abnormalities | **Drug toxicity<ref name="LangenbruchKrämer2019">{{cite journal|last1=Langenbruch|first1=Lisa|last2=Krämer|first2=Julia|last3=Güler|first3=Sati|last4=Möddel|first4=Gabriel|last5=Geßner|first5=Sophia|last6=Melzer|first6=Nico|last7=Elger|first7=Christian E.|last8=Wiendl|first8=Heinz|last9=Budde|first9=Thomas|last10=Meuth|first10=Sven G.|last11=Kovac|first11=Stjepana|title=Seizures and epilepsy in multiple sclerosis: epidemiology and prognosis in a large tertiary referral center|journal=Journal of Neurology|volume=266|issue=7|year=2019|pages=1789–1795|issn=0340-5354|doi=10.1007/s00415-019-09332-x}}</ref> | ||
**[[Eclampsia]] | |||
==Differentiating Status epilepticus from other Diseases== | ==Differentiating Status epilepticus from other Diseases== | ||
Revision as of 17:23, 5 October 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]
Synonyms and keywords:
Overview
Historical Perspective
- Status epilepticus was included in the classification of seizures of the International League Against Epilepsy of 1970 and 1981.[1]
Classification
- There is no established system for the classification of status epilepticus.
- However, status epilepticus can be divided into:
- Generalized Convulsive Status Epilepticus(GCSE), seizures last more that five minutes with tonic-clonic movement.
- Non-convulsive Status Epilepticus can be identified on electroencephalogram(EEG) with no motor convulsive activity (e.g persistent absence seizure)
- Focal seizure affecting a group of muscle with/without loss of consciousness.
- Myoclonic status epilepticus with prolonged jerks and epileptiform discharges on EEG.
- Refractory status epilepticus, continuous seizure not responding to treatment.[2] [3]
Pathophysiology
Causes
- Following are the conditions that could lead to a status epilepticus:
- Epilepsy: Approximately twenty-five percent of patients with status epilepticus have epilepsy.[4]
- Stroke[4]
- Infections:
- CNS: Meningitis, encephalitis or brain abscess
- Other infections leading to high fever, especially in children
- Metabolic abnormalities: This could be a result of underlying renal or hepatic pathology causing hyponatremia, hypoglycemia or hypocalcemia.
- Cerebral trauma or cerebrovascular accidents due to hypertensive crisis.[5]
- Alteration in anticonvulsive therapy including but not limited to sudden withdrawal or sub-optimal dosing, concomitant alcohol consumption, inadequate nutrition, starting a new medication that is non-compatible with anticonvulsive drugs and/or drug resistance.
- Hypoxia[5]
- Drug toxicity[5]
- Eclampsia
Differentiating Status epilepticus from other Diseases
- Status epilepticus must be differentiated from other disorders that may mimic the clinic presentation such as neuroleptic malignant syndrome and delerium tremens.
Epidemiology and Demographics
- The incidence of status epilepticus is approximately 7 to 40 cases per 100,000/year.
- Status epilepticus seems to be more common in male.
Risk Factors
Screening
Natural History, Complications, and Prognosis
- Common complications of status epilepticus include cardiac dysrhythmia, metabolic derangements, autonomic dysfunction, neurogenic pulmonary edema, hyperthermia, rhabdomyolysis, and aspiration pneumonia. [6]
- Permanent neurologic damage can occur with prolonged status epilepticus.
- Prognosis of status epilepticus depends upon the underlying cause, age, and medical condition of the patient. Overall mortality rate of status epilepticus is 7%–39%.[7]
- Approximately 10 to 30% of patients with underlying brain condition who have status epilepticus die within 30 days.[8]
- Patients with epilepsy and who develop status epilepticus have increased mortality risk. However, stabilizing condition and optimal maintenance of medication, sleep, stress factors and stimulants plays an important role in improving prognosis. [4]
Treatments
- ↑ "A Proposed International Classification of Epileptic Seizures". Epilepsia. 5 (4): 297–306. 1964. doi:10.1111/j.1528-1157.1964.tb03337.x. ISSN 0013-9580.
- ↑ Won, Sae‐Yeon; Dubinski, Daniel; Sautter, Lisa; Hattingen, Elke; Seifert, Volker; Rosenow, Felix; Freiman, Thomas; Strzelczyk, Adam; Konczalla, Juergen (2019). "Seizure and status epilepticus in chronic subdural hematoma". Acta Neurologica Scandinavica. 140 (3): 194–203. doi:10.1111/ane.13131. ISSN 0001-6314.
- ↑ Harrison's Manual of Medicine 19th Edition
- ↑ 4.0 4.1 4.2 Stasiukynienė, Virginija; Pilvinis, Vidas; Reingardienė, Dagmara; Janauskaitė, Liuda (2009). "Epileptic seizures in critically ill patients". Medicina. 45 (6): 501. doi:10.3390/medicina45060066. ISSN 1010-660X.
- ↑ 5.0 5.1 5.2 Langenbruch, Lisa; Krämer, Julia; Güler, Sati; Möddel, Gabriel; Geßner, Sophia; Melzer, Nico; Elger, Christian E.; Wiendl, Heinz; Budde, Thomas; Meuth, Sven G.; Kovac, Stjepana (2019). "Seizures and epilepsy in multiple sclerosis: epidemiology and prognosis in a large tertiary referral center". Journal of Neurology. 266 (7): 1789–1795. doi:10.1007/s00415-019-09332-x. ISSN 0340-5354.
- ↑ Sutter, Raoul; Dittrich, Tolga; Semmlack, Saskia; Rüegg, Stephan; Marsch, Stephan; Kaplan, Peter W. (2018). "Acute Systemic Complications of Convulsive Status Epilepticus—A Systematic Review". Critical Care Medicine. 46 (1): 138–145. doi:10.1097/CCM.0000000000002843. ISSN 0090-3493.
- ↑ Towne, Alan R.; Pellock, John M.; Ko, Daijin; DeLorenzo, Robert J. (1994). "Determinants of Mortality in Status Epilepticus". Epilepsia. 35 (1): 27–34. doi:10.1111/j.1528-1157.1994.tb02908.x. ISSN 0013-9580.
- ↑ Al-Mufti, Fawaz; Claassen, Jan (2014). "Neurocritical Care". Critical Care Clinics. 30 (4): 751–764. doi:10.1016/j.ccc.2014.06.006. ISSN 0749-0704.