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Convulsive status epilepticus in adults: Classification, clinical features, and diagnosis

INTRODUCTION

Status epilepticus is a relatively common medical and neurologic emergency that requires prompt evaluation and treatment. There are many different status epilepticus syndromes, defined by clinical features and EEG findings. Causes, prognoses, and treatments differ, and optimal evaluation and treatment requires an understanding of both the type of status epilepticus and the underlying cause. Some forms of status epilepticus have an excellent prognosis, whereas others have a high likelihood of mortality.

The clinical features and diagnosis of convulsive status epilepticus in adults is discussed here; treatment is reviewed separately. Nonconvulsive status epilepticus and the diagnosis and management of status epilepticus in children are also discussed separately. (See "Convulsive status epilepticus in adults: Treatment and prognosis" and "Nonconvulsive status epilepticus" and "Clinical features and complications of status epilepticus in children" and "Management of convulsive status epilepticus in children".)

DEFINITION

The International League Against Epilepsy (ILAE) defined status epilepticus more than 20 years ago as a single epileptic seizure of >30 minutes duration or a series of epileptic seizures during which function is not regained between ictal events in a 30 minute period [1]. This 30 minute criterion has been the standard in most epidemiologic studies [2].

Because of the clinical urgency in treating generalized convulsive status epilepticus (GCSE), however, a 30 minute definition is neither practical nor appropriate in clinical practice. Once seizures have continued for more than a few minutes, treatment should begin.

Considering the need for rapid evaluation and intervention in GCSE, an accepted operational definition of status epilepticus consists of the following [3,4]:

               

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Literature review current through: Nov 2014. | This topic last updated: Oct 29, 2014.
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References
Top
  1. Guidelines for epidemiologic studies on epilepsy. Commission on Epidemiology and Prognosis, International League Against Epilepsy. Epilepsia 1993; 34:592.
  2. DeLorenzo RJ, Hauser WA, Towne AR, et al. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology 1996; 46:1029.
  3. Lowenstein DH, Bleck T, Macdonald RL. It's time to revise the definition of status epilepticus. Epilepsia 1999; 40:120.
  4. Brophy GM, Bell R, Claassen J, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care 2012; 17:3.
  5. Chen JW, Wasterlain CG. Status epilepticus: pathophysiology and management in adults. Lancet Neurol 2006; 5:246.
  6. Treiman DM, Meyers PD, Walton NY, et al. A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med 1998; 339:792.
  7. Chin RF, Neville BG, Scott RC. A systematic review of the epidemiology of status epilepticus. Eur J Neurol 2004; 11:800.
  8. Wu YW, Shek DW, Garcia PA, et al. Incidence and mortality of generalized convulsive status epilepticus in California. Neurology 2002; 58:1070.
  9. Hauser WA. Status epilepticus: epidemiologic considerations. Neurology 1990; 40:9.
  10. Barry E, Hauser WA. Status epilepticus: the interaction of epilepsy and acute brain disease. Neurology 1993; 43:1473.
  11. Hesdorffer DC, Logroscino G, Cascino G, et al. Incidence of status epilepticus in Rochester, Minnesota, 1965-1984. Neurology 1998; 50:735.
  12. Coeytaux A, Jallon P, Galobardes B, Morabia A. Incidence of status epilepticus in French-speaking Switzerland: (EPISTAR). Neurology 2000; 55:693.
  13. Boyd JG, Taylor S, Rossiter JP, et al. New-onset refractory status epilepticus with restricted DWI and neuronophagia in the pulvinar. Neurology 2010; 74:1003.
  14. Wilder-Smith EP, Lim EC, Teoh HL, et al. The NORSE (new-onset refractory status epilepticus) syndrome: defining a disease entity. Ann Acad Med Singapore 2005; 34:417.
  15. Costello DJ, Kilbride RD, Cole AJ. Cryptogenic New Onset Refractory Status Epilepticus (NORSE) in adults-Infectious or not? J Neurol Sci 2009; 277:26.
  16. Rathakrishnan R, Wilder-Smith EP. New onset refractory status epilepticus (NORSE). J Neurol Sci 2009; 284:220; author reply 220.
  17. Bausell R, Svoronos A, Lennihan L, Hirsch LJ. Recovery after severe refractory status epilepticus and 4 months of coma. Neurology 2011; 77:1494.
  18. Juul-Jensen P, Denny-Brown D. Epilepsia partialis continua. Arch Neurol 1966; 15:563.
  19. Thomas JE, Reagan TJ, Klass DW. Epilepsia partialis continua. A review of 32 cases. Arch Neurol 1977; 34:266.
  20. Singh BM, Strobos RJ. Epilepsia partialis continua associated with nonketotic hyperglycemia: clinical and biochemical profile of 21 patients. Ann Neurol 1980; 8:155.
  21. Singh BM, Gupta DR, Strobos RJ. Nonketotic hyperglycemia and epilepsia partialis continua. Arch Neurol 1973; 29:187.
  22. Asconapé J, Penry JK. Some clinical and EEG aspects of benign juvenile myoclonic epilepsy. Epilepsia 1984; 25:108.
  23. Jumao-as A, Brenner RP. Myoclonic status epilepticus: a clinical and electroencephalographic study. Neurology 1990; 40:1199.
  24. Celesia GG, Grigg MM, Ross E. Generalized status myoclonicus in acute anoxic and toxic-metabolic encephalopathies. Arch Neurol 1988; 45:781.
  25. GASTAUT H, ROGER J, OUAHCHI S, et al. An electro-clinical study of generalized epileptic seizures of tonic expression. Epilepsia 1963; 4:15.
  26. Somerville ER, Bruni J. Tonic status epilepticus presenting as confusional state. Ann Neurol 1983; 13:549.
  27. Devinsky O, Kelley K, Porter RJ, Theodore WH. Clinical and electroencephalographic features of simple partial seizures. Neurology 1988; 38:1347.
  28. Reiher J, Rivest J, Grand'Maison F, Leduc CP. Periodic lateralized epileptiform discharges with transitional rhythmic discharges: association with seizures. Electroencephalogr Clin Neurophysiol 1991; 78:12.