DESCRIPTION

• Convulsive status epilepticus (SE) is defined as a continuous convulsive seizure with impaired awareness lasting >5 minutes or recurrent seizures without return to baseline in between.
• Five minutes is the time window at which urgent treatment should begin, as the seizure is unlikely to self-terminate.
• If SE continues >30 minutes, long-term consequences, including neuronal injury, alternative or neuronal networks, and neuronal death, may occur.
• Other forms of SE:
  • Nonconvulsive SE, persistent encephalopathy
  • Focal SE with impaired awareness
  • Focal SE with preserved awareness (epilepsia partialis continua)
  • Absence SE
  • Myoclonic SE

EPIDEMIOLOGY

• Incidence in pediatric patients is 20/100,000.
• ~40–70% of children have no history of seizures.

RISK FACTORS

• Known epilepsy
• Remote or acute central nervous system (CNS) insult
• History of previous SE
• Low anticonvulsant drug levels
• Younger age

GENERAL PREVENTION

• Adherence to the anticonvulsant medication regimen and clinical follow-up in patients with epilepsy
• Prompt treatment of convulsive seizures

PATHOPHYSIOLOGY

SE may be related to acute or chronic factors or frequently of unknown etiology.

• Febrile SE in early childhood (most common)
• Medications: low anticonvulsant drug levels or abrupt withdrawal of anticonvulsants, inappropriate anticonvulsants
• Intoxications
• Metabolic disturbances: electrolyte imbalances, hypoglycemia, organ failure
• CNS infections
• Genetic, mitochondrial, or metabolic disorders
• Structural etiologies
  • Head trauma
  • Ventriculoperitoneal (VP) shunt, especially due to malfunction
  • Cerebrovascular diseases (ischemic stroke, intracerebral hemorrhage, sinus venous thrombosis, posterior reversible leukoencephalopathy syndrome)
  • Cerebral hypoxia/anoxia
  • Intracranial tumors
  • Cortical dysplasia
  • Brain malformations, including neurocutaneous syndromes