Status Epilepticus

Abstract

Status epilepticus (SE) is a neurologic emergency given its high mortality and morbidity potential and takes place when physiologic mechanisms of seizure termination are impaired or overwhelmed. Over the course of several decades, multiple SE definitions have been proposed based on seizure duration and clinical semiology of seizures, therapeutic response (or lack thereof), and etiology. These definitions target a more precise characterization of each clinical syndrome associated with SE, which has distinct prognostic and therapeutic implications. Given the significant morbidity and mortality associated with SE, early diagnosis and treatment is of utmost importance. The clinical exam and electroencephalography remain the mainstays of diagnosis and assist in guiding therapeutic approaches, which include timely administration of first-line therapy (benzodiazepines) and a subsequent tiered approach that may include non-sedating medications, deep anesthesia, immunotherapy, ketogenic diet, and empiric surgery in selected cases. National and international guidelines are available to assist with a standardized approach to SE; however, in clinical practice, it is imperative to individualize therapy according to the etiology of seizures, patient’s comorbidities, and the nature of seizures (convulsive vs nonconvulsive, focal vs generalized). This chapter provides a focused yet comprehensive review of SE, including proposed definitions, pathophysiology, etiology, epidemiology, diagnosis, treatment, complications, and prognosis.