Convulsive status epilepticus in adults: Classification, clinical features, and diagnosis
- Frank W Drislane, MD
Frank W Drislane, MD
- Professor of Neurology
- Harvard Medical School
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 are associated with an excellent prognosis, while others can have major morbidity or even 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".)
The duration of continuous seizure activity used to define status epilepticus has varied over time. Historically, the International League Against Epilepsy (ILAE) and others defined status epilepticus 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 .
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 without further delay.
Considering the need for rapid evaluation and intervention in GCSE to avoid cardiovascular morbidity and refractory status, an accepted operational definition of GCSE consists of the following [2-4]:
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- CLINICAL FEATURES
- Generalized convulsive status epilepticus
- Focal motor status epilepticus
- Myoclonic status epilepticus
- Tonic status epilepticus
- DIFFERENTIAL DIAGNOSIS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS