Neurology

Status Epilepticus

Convulsive status epilepticus is a self-sustaining seizure state in which gamma-aminobutyric acid (GABA) inhibition fails, so seizures no longer stop spontaneously and grow harder to treat every minute.

Definition

Convulsive status epilepticus is a generalised tonic-clonic seizure lasting 5 minutes or more, or two or more seizures without full recovery of consciousness between them. Status also occurs focally and without prominent motor signs, where the diagnosis rests on the electroencephalogram.

First principles

Five minutes, not thirty, because a seizure still running at five minutes will not stop itself

The International League Against Epilepsy defines status epilepticus using two time points. The first, at 5 minutes for a tonic-clonic seizure, is the point at which the seizure is unlikely to stop on its own and treatment must start. The second, at around 30 minutes, is when neuronal injury begins. The older definition used the 30-minute figure as the trigger to treat, which meant treatment arrived after the damage had started. Most tonic-clonic seizures stop within 2 to 3 minutes, so one that is still going at 5 minutes is already abnormal.

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