Management of the seizure itself is very important however we must also think about why the seizure is occurring. It would therefore make sense that the earlier a seizure is treated, the better the potential control of that seizure and thus the outcome.
However, glutamate-sensitive N-methyl-D-aspartate (NMDA) receptors significantly increase(9). It appears that during prolonged seizures, the number of activated GABA-A receptors on the postsynaptic membrane gradually decreases as they are internalised(8). Most of the medications we use for the treatment of seizures, including midazolam, valproic acid, propofol, act on GABA receptors. The 30 minute landmark, where neuronal damage is believed to occur and pharmaco-resistance develops, is controversial and it is now believed that these things occur much earlier(7). A seizure lasting more than 30 minutes is associated with up to 19% mortality(5), and those with refractory status epilepticus have a mortality as high as 60%(6). Those that don’t, don’t tend to stop spontaneously(4). The times of 5 minutes and 30 minutes are important landmarks. Super Refractory Status Epilepticus is drug resistant status that either persists or recurs despite continuous intravenous anaesthetics for more than 24 hours.(3) Refractory Status Epilepticus is a seizure that doesn’t resolve following administration of benzodiazepines and anticonvulsants.(2) Currently it is defined as any seizure lasting longer than 5 minutes, without a return to normal consciousness, or recurrent seizures without a return to normal consciousness between seizures.Įstablished Status Epilepticus is a seizure that continues following administration of first line medications such as benzodiazepines Status Epilepticus: The definition has changed over the years. About 5% of adults and up to 25% of children with epilepsy will have at least one episode of status epilepticus. The length of status epilepticus is important in terms of patient survival. We recognise it in patients where they have a depressed conscious state accompanied by tonic clonic movements of the extremities. Convulsive Status Epilepticus accounts for up to 75% of all status epilepticus(1).
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