Status Epilepticus

A seizure involves abnormal electrical activity in the brain. It affects both the mind and the body. Many problems can cause you to have a seizure. These include:

• High fever.

• Brain infections.

• Abnormal sodium or blood sugar levels.

• Head injuries.

If you have epilepsy, you may have seizures again and again. You may have status epilepticus if you have a seizure that lasts longer than 5 minutes, or if you have more than 1 seizure within a 5-minute period, without returning to a normal level of consciousness between episodes. This is a medical emergency. It may lead to permanent brain damage or death.

Most people with epilepsy will never have status epilepticus. This condition is more common in young children and elderly adults. At UC Heath, we treat multiple cases per month. 

This condition can occur as:

• Convulsive status epilepticus. This type occurs with convulsions. It may be more likely to lead to long-term injury. Convulsions may involve jerking motions, grunting sounds, drooling, and rapid eye movements.

Nonconvulsive status epilepticus. People with this type may appear confused or look like they're daydreaming. They may be unable to speak. They may also behave in an irrational way. Some patients in an ICU with this disorder just appear to be in a coma.

In children, the main cause of status epilepticus is an infection with a fever. In adults, the common causes are:

• Stroke.

• Imbalance of substances in the blood, such as low blood sugar.

• Drinking too much alcohol or having alcohol withdrawal after previous heavy alcohol use.

• Withdrawal from medicines to treat seizures.

• Traumatic brain injury.

There are many risk factors for status epilepticus, such as:

• Poorly controlled epilepsy.

• Low blood sugar.

• Stroke.

• Kidney failure.

• Liver failure.

• Encephalitis (swelling or inflammation of the brain).

• HIV.

• Alcohol or drug abuse.

• Genetic diseases such as Fragile X syndrome and Angelman syndrome.

• Head injuries.

These are possible symptoms of status epilepticus:

• Muscle spasms.

• Falling.

• Confusion.

• Loss of bowel or bladder control.

• Clenched teeth.

• Irregular breathing.

• Strange behavior.

• Trouble speaking.

• A "daydreaming" look.

Your healthcare provider will do a physical exam. They may also order an electroencephalogram. This involves placing painless electrodes onto your scalp to measure the brain's electrical activity. Our epilepsy and ICU treatment teams pioneered the use of emergency EEG and many of the treatments used in status epilepticus.

You may need other tests to search for possible causes, such as:

• Lumbar puncture (spinal tap) to look for signs of infection

• CT or MRI scan to see problems in the brain

The healthcare provider will want to end the seizure as quickly as possible and treat any underlying problems that are causing it. You may need:

• Oxygen.

• Blood tests.

• An IV (intravenous) line.

• Glucose (sugar) if low blood sugar may be causing the seizure.

Healthcare providers may also use anti-seizure medicines to treat the problem, such as:

• Diazepam

• Lorazepam

• Phenytoin

• Fosphenytoin

• Phenobarbital

• Valproate

• Levetiracetam

These medicines are given through an IV or an injection into a muscle.

Complications depend on the underlying cause. They can range from no problems to death. If the cause, such as poor epilepsy control, can be fixed, there may be no problems. If the cause is a stroke or brain injury, a person may suffer physical disability to even death.

If you have epilepsy, taking your medicines as directed may help you avoid this problem. If you’ve had status epilepticus, you may need to begin taking seizure medicines or change medicines you’re already taking. You may also be able to prevent this health problem by:

• Taking your anti-seizure medications as prescribed.

• Not abusing alcohol.

• Getting adequate sleep.