Status Epilepticus Treatment in Mumbai, India

A seizure, or a fit, is a condition that involves abnormal electrical activity of the brain. Normally, a seizure lasts for around 2 minutes or less. Status Epilepticus translates to “a continuous state of seizure”.

It occurs when a seizure lasts too long, typically longer than 5 minutes. Sometimes, seizures occur in close intervals, and during others, there is no recovery time between two seizures.

Associated Anatomy

The nervous system, mainly the brain

Alternate Name

Prolonged Seizures

Status Epilepticus Symptoms

Status Epilepticus presents as normal seizures which fail to subside within 2 minutes, or as two continuous seizures with no recovery in between. Signs and symptoms include:

• Muscle spasms may lead to sudden movements. They may also have trouble speaking.
• Convulsions that involve jerky motions of the body, and rapid eye movements
• Loss of bowel or bladder control
• Clenched teeth, grunting or other unusual noises, and drooling
• Irregular breathing
• Strange behaviour with a distant look in the eyes

Depending on these symptoms, the seizures can be classified as convulsive or non-convulsive.

Status Epilepticus Causes

Most people, even those with chronic seizure disorders, are not likely to have Status Epilepticus. However, only 15% of such cases are reported. These are usually triggered by:

• High fever: This is the main cause of Status Epilepticus in children, and is usually accompanied by an infection.
• Stroke: Adults suffering from stroke usually show longer seizures as the oxygen levels in the brain get depleted.
• Imbalance of substances in the blood: Very rarely, events such as low blood sugar can cause continuous seizures.
• HIV: An HIV infection makes the body much more susceptible to failing to recover between seizures, resulting in longer seizures.
• Head Trauma: Head trauma may cause significant damage to the brain resulting in seizures
• Heavy alcohol use: Heavy alcohol concentration or a state of withdrawal after long bouts of alcohol use can cause seizures.
• Kidney or liver failure: Organ failure may lead to abnormal compounds being present in the blood, leading to seizures.
• Encephalitis: Children who are down with encephalitis or brain inflammation can show Status Epilepticus.
• Genetic disorders: Fragile X syndrome and Angelman syndrome exacerbate the symptoms of seizures, making it more likely for Status Epilepticus to occur.

Status Epilepticus Additional Types

An additional type of Status Epilepticus is called Background Refractory status epilepticus (RSE). This is a life-threatening condition where the seizures do not subside on being treated with first or second-line anticonvulsant drugs.

Status Epilepticus Stages

There are two main types of Status Epilepticus - convulsive and non-convulsive. The convulsive type is more common and more dangerous. It is presented in the following stages:

1. Tonic phase (usually lasts less than 1 minute) - The body spasms and becomes stiff. There will be a loss of consciousness. Symptoms presented as eyes rolling back into the head, contraction of muscles, stiffness of the back, and trouble in breathing.
2. Clonic phase - Jerking of the body and flexing of the limbs. This is accompanied by rapid, jerky body movements. When the jerking stops, the postictal period begins, which shows up as a loss of consciousness.

Consistent observation of these two stages happens during Status Epilepticus, mostly with no recovery periods in between.

Typical Test Required For Status Epilepticus

Status Epilpeticus is typically diagnosed using an Electroencephalogram. This involves placing painless electrodes onto the scalp to measure the brain's electrical activity. However, this just detects abnormal electrical activity and diagnoses the activity of seizures. For determining the type of seizures and the cause behind it, other tests such as CT, MRI, Spinal Tap, etc. may be performed.

Status Epilepticus Treatment

• Status Epilepticus is a grade 1 medical emergency. Do not try treating it at home. If you suspect someone is having a seizure, contact a doctor immediately or rush to a medical center where appropriate help will be provided.
• As per the symptoms, neurologists may opt for anti-epileptic drugs such as:
  • Diazepam
  • Lorazepam
  • Phenobarbital
  • Valproate
  • Phenytoin
  • Fosphenytoin

These drugs may be administered via IV or injection.

• Oxygen is administered first to prevent any damage to the brain cells due to hypoxia.
• If the seizure has been caused by low blood sugar, glucose will also be administered.
• Many times, doctors may also recommend surgery or neurostimulation devices, especially if Status Epilepticus is caused due to chronic seizure disorders.

Status Epilepticus Risk Factors

• People with chronic seizure disorders are more likely to have Status Epilepticus if their epilepsy is managed poorly.
• Low blood sugar in diabetics may also lead to Status Epilepticus.
• Multi-organ failure, especially kidney or liver failure, increases the risk for seizures.
• Brain infections such as Encephalitis may exacerbate the chances of uncontrolled seizures.
• Having immune response suppressing disorders like HIV infections can put you at risk for seizures.
• Other risk factors include unabashed drug or alcohol use.

Status Epilepticus Complications

Status Epilepticus may escalate into potential complications like cardiac damage or abnormal heart rates, respiratory failure, a cut-off of oxygen to the brain leading to cell damage, pneumonia, pulmonary edema, fever, and leukocytosis.

Status Epilepticus Prevention

Primary Prevention

• Effective primary prevention strategies for Status Epilepticus are the same as those for Chronic Epilepsy.
• These include reducing the chances of seizure occurrence due to head trauma or low blood sugar, or cerebral palsy.
• Avoiding drug and alcohol abuse and seizure triggers like sleep deprivation, fevers, lights, etc. are also pertinent.

Secondary Prevention

• Secondary prevention involves screening of biomarkers that may aggravate epilepsy.
• If the seizures are chronic, the doctor may recommend surgery or neurostimulation devices.

Status Epilepticus Diagnosis

Conditions such as acute intoxication, early catastrophic brain hypoxia, encephalopathy, ischemic stroke, non-epileptic seizures, or trauma are usually considered differential diagnoses for Status Epilepticus.

Epidemiology

• Status Epilepticus is rare. It is reported only for 7 to 40 cases for every 100,000 persons/year.
• Up to 40% of these cases already have a history of epilepsy.
• Status Epilepticus is also more common in males.

Status Epilepticus Prognosis

Expected Prognosis

The mortality rate for Status Epilepticus patients is around 16 to 20%. It escalates into death only if a significant cut-off of oxygen to the brain occurs. If the seizures are unresponsive to first and second-line anticonvulsant medications, the mortality increases to 35 to 60%.

Natural Progression

If left untreated, Status Epilepticus almost always results in death or a vegetative state as the body reaches a state of constant muscle spasm and oxygen flow to the brain is cut off.

Pathophysiology

A seizure is caused by abnormal electrical in the brain. This may show up as disrupted behaviour and is caused by abnormal excitation or inhibition of neurotransmitters in the brain.

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