A group of disorders in which there
are recurrent episodes of altered
cerebral function associated with
paroxysmal excessive and
hypersynchronous discharge of
cerebral neurones giving rise to
Genetic, congenital, and
developmental conditions implicated
in young patients.
Tumours more likely after 40 years
Head trauma, CNS infections may
occur at any age.
Organized according to whether the
source in the brain is localize:
Partial or focal/generalised onset of
Paroxysmal neuronal activity is limited to
one part of the cerebrum.
Partial seizures further divided
depending on the extent to which
consciousness is affected.
If unaffected - simple partial
Otherwise complex partial(psychomotor
Partial seizure may spread within the
brain by a process known as
If activity spreads to involve the
reticular activating system at the
thalamic level, awareness is lost and
a ‘complex partial seizure’ results.
May further lead to a secondary
It is sometimes possible to have
generalized seizure with no clear
Generalised seizures are also divided
according to the effect on the body
however all invove loss of
consciouness. These include:
Absence (petit mal)
tonic-clonic (grand mal)
Seizure characterized by rhythmical jerking
or sustained spasm of the affected parts.
They may remain localized to one part or
may spread to involve the whole side.
Some attacks begin on one part e.g.
mouth, thumb and great toe and spread
gradually - Jacksonian epilepsy.
Attacks vary in duration from a few
seconds to several hours.
More prolong episode may leave
paresis of the involve limb for several
hours after seizure has ceased -
Seizures arises from postcentral
gyrus causing tingling or electric
sensations in the contralateral face
May sometimes spread to become
A frontal epileptic focus.
May involve the frontal eye field
causing forced deviation of the eyes
to the opposite side.
May progress to generalized tonic-
Occipital epileptic foci
Visual hallucinations e.g.
Balls of light
Patterns of colour
Temporal lobe (anterior portion)
Formed visual hallucinations of faces or
Hours or days before attack, uneasy, irritability
Olfactory and jerking of one limb
Rapid discharging of motor cortex cells causing
tonic contraction of muscles; arms flexed and
adducted, legs extended:
respiratory muscle spasm causes ‘cry’ as air
expelled; cyanosis; loss of consciousness. Last
Slow discharge of cortical cells;
jerking of face and limbs;
Last 1-5 minutes
Deep unconsciousness, flaccid limbs and jaw,
loss of corneal reflexes, extensor plantar
What Triggers seizures
Alcohol or alcohol withdrawal
Withdrawal of medication
Generalized convulsive status
Consist of sustained
unconsciousness and continuous or
intermittent generalized convulsive
Status epilepticus can be defined as
10-30 minutes of continuous seizure
A series of seizures without return to
full consciousness between the
Sex: affects males and females
Age: Status epilepticus occurs in all
age groups but more frequently at the
extremes of age.
In the elderly have an increased
incidence of status epilepticus
secondary to ischaemic CNS insults.
Mortality rate could be as high as
Death often is related to an underlying
cause of brain injury.
Mortality rate is highest in elderly
patients with hypoxic or ischaemic
central nervous system (CNS) insults.
Exacerbation of an idiopathic seizure
First onset of a seizure disorder (usually a
diagnosis of exclusion).
Toxic or metabolic causes
Electrolyte abnormalities eg,
Infectious etiology eg
CNS inflammatory processes
systemic or CNS neoplasms
As an initial presentation of a seizure
Noncompliance with medications
involvement in a motor vehicle accident
rhythmic tonic-clonic activity is
Consciousness is impaired.
Sometimes, status epilepticus may
present as a persistent tonic seizure.
Suspect subtle status epilepticus in
any patient who does not regain
consciousness within 20-30 minutes
of cessation of generalized seizure
At times all motor activity may be
Associated injuries that may be
present in patients with seizures
Clinical information should guide the
ordering of laboratory tests.
low yield of multiple laboratory tests in
evaluation of patients presenting with
a single seizure.
Status epilepticus should prompt a
search for the etiology of status or
potentially reversible conditions.
Electrolytes, BUN, Creatinine, Na and
Calcium (especially in malignancy).
Liver function test
Serum levels of antiepileptic drugs
Urine levels of drugs
Arterial blood gas analysis
Aggressive supportive care including
Prompt termination of electrical
Nasopharyngeal airway placement is
sufficient for some patients, particularly if
the seizures are stopped and the patient
For other patients, endotracheal
intubation is necessary.
At times, rapid sequence induction, with
neuromuscular paralysis, is necessary.
Employ short-acting paralytics so
that ongoing seizure activity is not
Employ EEG monitoring if long-
acting paralytics are used and if a
question exists about seizure
Initiate rapid glucose determination and
Establish IV access, ideally in a large
IV administration is the preferred route for
anticonvulsant administration because it
allows therapeutic tissue levels to be
attained more rapidly.
Establish cardiac and other
Iv Thiamine 100mg followed by 50mls
of 50% dextrose
0.1 mg/kg at 2mg/min not exceeding 4mg or
0.2 mg/kg at 5mg/min up to 10mg
Plus maintainance anticonvulsants
*Beware of the side effects of
Monitor BP, pulse rate and rhythm.
Refractory status epilepticus.
Failure to respond to optimal
benzodiazepine and phenytoin
*Sometimes continuous infusion of
General principle is to maximize
the dosage of each drug before
adding an additional agent.
Special consideration of Isoniazid
Isoniazid (INH) toxicity may present
Give Pyridoxine (Vitamin B6)
Specific antidote for managing INH-
Anticonvulsant therapy compliance
Stress the importance of regular
medical attention for medication
The importance of follow-up visits to
adjust medications and for further
medical workup and care.
Prognosis is related strongly to the
underlying process causing status
epilepticus. E.g., if meningitis is the
etiology, the course of that disease dictates
Patients with status epilepticus from
anticonvulsant irregularity or those with
alcohol-related seizures generally have a
favorable prognosis if treatment is
commenced rapidly and complications are