Advertisement

Types of Status Epilepticus: Definitions and Classification

  • Eugen TrinkaEmail author
Chapter
Part of the Current Clinical Neurology book series (CCNEU)

Abstract

Status epilepticus (SE), the “maximum expression of epilepsy” (derived etymologically from the original term status in Latin), was defined in the 1962 Xth Marseilles Colloquium to be “… a term [used for] a seizure that persists for a sufficient length of time or is repeated frequently enough to produce a fixed and enduring condition.” Although no duration was then specified, Gastaut later proposed 60 min as a minimum, and later hypothesized that the many types of status reflected the many types of epileptic seizures. SE mirrored the seizure classification and was divided into partial, generalized, or unilateral types. In 1981 “…recovery between attacks does not occur,” was added. The 2006 ILAE report defined it “mechanistically” as “the failure of the natural homeostatic seizure-suppressing mechanisms responsible for seizure termination” without noting specific duration. Timelines in clinical trials and treatment have been moved progressively to 20, then 10 min. The 2009 classification provided two dimensions: a conceptual approach from scientific evidence, and an operational frame to guide management. Hence, “Status epilepticus is a condition resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms, which lead to abnormally prolonged seizures (after time-point t1). It is a condition, which can have long-term consequences (after time point t2), including neuronal death, neuronal injury, and alteration of neuronal networks, depending on the type and duration of seizures.” Research suggested 5 min for generalized tonic–clonic seizures, a t1 of ~10 min for focal seizures when treatment should be considered. At t2 (~30 min) damage to neuronal networks may begin, warranting aggressive treatment. In 2015, four axes were delineated: (1) semiology, (2) etiology, (3) EEG correlates, and (4) age. Motor activity and disturbance of consciousness guide clinical management. Future research should establish t1 and t2 for different SE types.

Keywords

Status epilepticus Epilepsy Definition of status Time-points for neuronal damage Treatment Four axes of status epilepticus 

References

  1. 1.
    Gastaut H. A propos d’une classification symptomatologique des états de mal épileptiques. In: Gastaut H, Roger J, Lob H, editors. Les états de mal épileptiques. Paris: Masson; 1967. p. 1–8.Google Scholar
  2. 2.
    Gastaut H. Classification of status epilepticus. In: Delgado-Escueta AV, Wasterlain CG, Treiman DM, Porter RJ, editors. Status epilepticus—mechanisms of brain damage and treatment. Advances in Neurology, vol.34. New York: Raven Press; 1983. p. 15–35.Google Scholar
  3. 3.
    Gastaut H. Clinical and electroencephalographical classification of epileptic seizures. Epilepsia. 1970;11(l):102–12.Google Scholar
  4. 4.
    Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Terminology of the International League Against Epilepsy. Epilepsia. 1981;22(4):489–501.Google Scholar
  5. 5.
    Engel J. International league against epilepsy (ILAE). A proposed diagnostic scheme for people with epileptic seizures and with epilepsy: report of the ILAE Task Force on Classification and Terminology. Epilepsia. 2001;42(6):796–803.CrossRefPubMedGoogle Scholar
  6. 6.
    Engel J Jr. Report of the ILAE classification core group. Epilepsia. 2006;47(9):1558–68.CrossRefPubMedGoogle Scholar
  7. 7.
    Lowenstein DH, Bleck T, Macdonald RL. It’s time to revise the definition of status epilepticus. Epilepsia. 1999;40(1):120–2.CrossRefPubMedGoogle Scholar
  8. 8.
    Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S, et al. A definition and classification of status epilepticus—report of the ILAE task force on classification of status epilepticus. Epilepsia. 2015;56(10):1515–23.CrossRefPubMedGoogle Scholar
  9. 9.
    Berg AT, Berkovic SF, Brodie MJ, Buchhalter J, Cross JH, van Emde Boas W, et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE commission on classification and terminology, 2005–2009. Epilepsia. 2010;51(4):676–85.CrossRefPubMedGoogle Scholar
  10. 10.
    Bauer G, Trinka E. Seizures, syndromes and classifications. Epileptic Disord. 2009;8(2):162–3.Google Scholar
  11. 11.
    Theodore WH, Porter RJ, Albert P, Kelley K, Bromfield E, Devinsky O, et al. The secondarily generalized tonic-clonic seizure: a videotape analysis. Neurology. 1994;44(8):1403–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Shinnar S, Berg AT, Moshe SL, Shinnar R. How long do new-onset seizures in children last? Ann Neurol. 2001;49(5):659–64.CrossRefPubMedGoogle Scholar
  13. 13.
    Jenssen S, Gracely EJ, Sperling MR. How long do most seizures last? A systematic comparison of seizures recorded in the epilepsy monitoring unit. Epilepsia. 2006;47(9):1499–503.CrossRefPubMedGoogle Scholar
  14. 14.
    Dobesberger J, Ristic AJ, Walser G, Kuchukhidze G, Unterberger I, Hofler J, et al. Duration of focal complex, secondarily generalized tonic-clonic, and primarily generalized tonic-clonic seizures—a video-EEG analysis. Epilepsy Behav. 2015;49:111–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Meldrum BS, Brierley JB. Prolonged epileptic seizures in primates: ishemic cell change and its relation to ictal physiological events. Arch Neurology. 1973;28(1):10–7.CrossRefGoogle Scholar
  16. 16.
    Bauer G, Trinka E. Nonconvulsive status epilepticus and coma. Epilepsia. 2010;51(2):177–90.CrossRefPubMedGoogle Scholar
  17. 17.
    Trinka E, Leitinger M. Which EEG patterns in coma are nonconvulsive status epilepticus? Epilepsy Behav. 2015;49:203–22.CrossRefPubMedGoogle Scholar
  18. 18.
    Hirsch LJ, LaRoche SM, Gaspard N, Gerard E, Svoronos A, Herman ST, et al. American Clinical Neurophysiology Society’s standardized critical care EEG terminology: 2012 version. J Clin Neurophysiol. 2013;30(1):1–27.CrossRefPubMedGoogle Scholar
  19. 19.
    Beniczky S, Hirsch LJ, Kaplan PW, Pressler R, Bauer G, Aurlien H, et al. Unified EEG terminology and criteria for nonconvulsive status epilepticus. Epilepsia. 2013 Sep;54 Suppl 6:28–9.Google Scholar
  20. 20.
    Kaplan PW. EEG criteria for nonconvulsive status epilepticus. Epilepsia. 2007;48 Suppl 8:39–41.Google Scholar
  21. 21.
    Leitinger M, Beniczky S, Rohracher A, Gardella E, Kalss G, Qerama E, et al. Salzburg Consensus Criteria for Non-Convulsive Status Epilepticus—approach to clinical application. Epilepsy Behav. 2015;49:158–63.CrossRefPubMedGoogle Scholar
  22. 22.
    Kaplan PW. No, some types of nonconvulsive status epilepticus cause little permanent neurologic sequelae (or: “the cure may be worse than the disease”). Clin Neurophysiol. 2000;30(6):377–82.CrossRefGoogle Scholar
  23. 23.
    Shorvon S, Trinka E. Nonconvulsive status epilepticus and the postictal state. Epilepsy Behav. 2010;19(2):172–5.CrossRefPubMedGoogle Scholar
  24. 24.
    Rossetti AO, Trinka E, Stahli C, Novy J. New ILAE versus previous clinical status epilepticus semiologic classification: analysis of a hospital-based cohort. Epilepsia. 2016;57(7):1036–41.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media LLC 2018

Authors and Affiliations

  1. 1.Department of Neurology, Christian Doppler Medical CentreParacelsus Medical University, Centre for Cognitive NeuroscienceSalzburgAustria

Personalised recommendations