Blog #37: Status Epilepticus

(This blog was originally posted on September 3, 2013)

 

Approximately 1 to 16 percent of people with epilepsy experience seizures that last five or more minutes. This prolonged seizure is referred to as “status epilepticus,” and the seizure will be characterized by either convulsions (tonic-clonic seizure, See Blog #33) or periods of blanking out (complex partial seizure, See Blog #35). Each event originates in a different area of the brain and can last many minutes or even several hours.

·         Tonic-clonic status epilepticus: This type of seizure emanates from the central depths of the brain, but it can spread to both hemispheres and affect the whole brain. This form of epilepsy can be lethal if it goes on for too long because the convulsions impede/prevent breathing. If someone is convulsing for more than several minutes, it is important to get the patient medical help as soon as possible: intravenous anti-seizure medications can be given to help stop that seizure. If this fails, general anesthesia is used to try to stop the seizure and to preserve the brain cells that have not already been damaged by oxygen deprivation that occurred during the seizure.

·         Complex partial status epilepticus: This seizure begins in the temporal lobe, and occasionally in the frontal lobe. It may last several minutes, many hours or even days. To the uninitiated observer, someone who is in this state may appear to have a psychiatric problem, where the patient has “freaked out” and just acts strangely. The patient may even be referred to psychiatrists because of the unrecognized seizure. As oxygenation is not compromised in complex partial status epilepticus, anti-seizure medications may be administered orally or intravenously, as per the medical team’s judgment.

·          Subclinical, non-convulsive status epilepticus is believed to be the cause of coma in many seriously ill, unresponsive patients in the intensive care unit (ICU). These patients lie still, without responsiveness, yet they can be having continuous seizure activity seen if an electroencephalogram (EEG) is done. A routine eye examination with an ophthalmoscope at the bedside could diagnose this condition. I have occasionally been surprised to find that the optic disc—a structure in the back of the eyeball—is jerking back and forth in comatose patients. This may be the only part of the body demonstrating epileptic activity, which will be confirmed on the EEG.

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. DINGS is his first novel.