Status epilepticus - when it becomes an emergency
Most seizures last only a short time, around 1-3 minutes, and rarely need medical help. A prolonged seizure, however, is a medical emergency.
Status epilepticus, Latin for ’state of epilepsy’, is the name given to a continuous prolonged seizure lasting for at least 30 minutes, or a series of seizures that occur in succession for 30 minutes or more, when the person does not recover consciousness between seizures. When seizures go on for up to 5 minutes without signs of stopping, it is possible that status epilepticus may be developing, so that it is generally advised to seek emergency medical help after 5 minutes; or if the person does not recover consciousness; or if the seizure is longer than normal, or seems different in some way to its usual pattern. Generally, seizures which continue for longer than 5-10 minutes need treatment as soon as possible.
The threat of status epilepticus is usually held over your head if you discontinue anti-epileptic medicine, but what are the risks really? Although epilepsy rarely causes brain damage, convulsive status epilepticus (a progression of generalized tonic-clonic seizures) may cause brain damage and occasionally death in up to 10 per cent of people, though prompt medical treatment usually prevents this. Sometimes status may happen as a first seizure, and in this case, it is often a first and only seizure. Other types of prolonged seizures, such as prolonged generalized (such as absence) or partial seizures are less immediately dangerous in that they are less likely to cause brain damage, but should still be treated urgently. This type of non-convulsive status can rarely develop into the more dangerous convulsive kind.
Treatment consists of injecting anti-epileptic drugs such as diazepam. Status epilepticus is also sometimes related to not taking anti-epileptic drugs, and is a major reason why it is so important to take medication regularly and not to try and withdraw from anti-epileptic drugs without medical supervision.
The other occasion when you should summon medical help is in a first seizure, particularly if the seizure lasts more than around ten minutes, though most people will do this automatically.
Epilepsy syndromes One reason why doctors need to differentiate and classify different types of seizures is that sometimes these build into a recognizable syndrome. A syndrome is when certain symptoms occur together to form an identifiable medical condition. Recognizing different syndromes is in turn important because it can give a more accurate idea of the best treatment, and of the prognosis, or long-term outlook.
As well as the type of seizure, doctors need to know the age at which seizures began (many syndromes begin and/or end at certain ages), as well as a person’s general developmental or learning abilities. An EEG may also show up certain typical patterns. Some epilepsy syndromes have been identified; and many other syndromes which affect neurological function also include epilepsy. However, only around half of all people with epilepsy will be found to have a clear-cut epilepsy syndrome. Some syndromes are serious, and with a poor outlook, but these are thankfully quite rare. Two more common and relatively mild syndromes are Benign Rolandic Epilepsy of Childhood (BREC), which is usually outgrown by age 13-16, and juvenile myoclonic epilepsy (JME), which is thought to have a genetic cause, and which often begins in adolescence and is easily controlled.
Two much more rare and serious syndromes are West Syndrome, and the Lennox-Gastaut Syndrome - the first one, which affects babies, often develops into the second. West Syndrome (infantile spasms or salaam spasms) usually begins during the first year of life, and may be caused by developmental brain problems or brain damage. Lennox-Gastaut Syndrome (minor motor epilepsy or slow spike-wave epilepsy) typically involves frequent, hard-to-control seizures, and learning difficulties and development problems.