[Status epilepticus]

Abstract

Prolonged or repeated seizures--or status epilepticus (SE)--presents diagnostic and therapeutic problems and is one of the most common neurologic emergencies. SE is defined as seizure lasting longer then 30 minutes or the repetition of at least two seizures within a short period of time, independently of the patient's state of consciousness or the type of seizure. At least 10% of epileptic patients suffer an SE during the course of their disease. Fifty percent of SEs appear in patients with no known history of epilepsy. SE is more frequent in symptomatic epilepsies, particularly those arising from trauma, tumor or infection. Most are found in epilepsies involving the frontal lobe. SE is present in nearly all epileptic syndromes, even idiopathic ones, although it is more frequent in cryptogenic and symptomatic forms. Tonic-clonic SE is the best known type and its diagnosis is simple. Partial SE, above complex partial SE, presents a diagnostic challenge. Particularly difficult is the differential diagnosis of complex partial SE and absence SE, above all the form termed late-onset de novo absence SE, which presents as confusional syndrome in the elderly. The treatment of SE, which is always a medical emergency, is based on intravenous benzodiazepines along with phenytoin, barbiturates or both. We discuss the utility of other drugs, such as lidocaine and valproic acid i.v., as well as the possibility of drugs like phosphenytoin becoming available in the near future.