Definition: Status epilepticus, or epileptic status, is a condition in which consciousness is not fully restored between consecutive seizures and frequent recurrences, or the seizures do not stop on their own for more than 30 min. Prolonged (>30min) seizures, if left untreated, can lead to irreversible brain damage due to hyperthermia, circulatory collapse or toxic damage to neuronal excitation, with high rates of disability and death, making status epilepticus a common medical emergency. Status epilepticus can occur in any type of epilepsy and usually refers to a generalized tonic-clonic seizure continuum.
Status epilepticus occurs most often in patients with epilepsy, and is most commonly caused by inappropriate discontinuation of AEDs, or by acute encephalopathy, stroke, encephalitis, traumatic tumor and drug intoxication, etc. It can also be induced by irregular AEDs treatment, infection, psychiatric factors, excessive fatigue, maternity and alcohol consumption, etc. The cause of individual patients is unknown. Continuous status epilepticus or continuous seizures are seizures that occur continuously but with consciousness between seizures.
All kinds of seizures can occur, but tonic twinge status is the most common clinical condition. In generalized seizures, status epilepticuh (SE) is often accompanied by varying degrees of consciousness and motor dysfunction, and in severe cases, cerebral edema and increased cranial pressure. Even with active resuscitation, the death rate is still 3.6%. The incidence of neurological sequelae, such as mental retardation, paralysis and more severe seizures, is as high as 9%-20%.
The most common causes of seizures are sudden discontinuation and reduction of medication after starting standardized medication, untimely or non-compliant medication, multiple missed doses, self-medication discontinuation, “prescriptions” and random changes in medication dose or type, resulting in failure to achieve effective blood concentrations and causing status epilepticus in 2l% of children with epilepsy and 34% of adults. The result is that 2l% of children and 34% of adults with epilepsy develop status epilepticus.
Acute metabolic diseases Patients with acute metabolic diseases without a history of seizures have a history of seizure status as the first symptom in 12% to 41% of patients with a history of epilepsy have a history of seizure status as a recurrent symptom in 5%.
Triggering factors Fever, infection, exertion, alcohol consumption, alcohol withdrawal, pregnancy and childbirth, discontinuation of sedatives, isoniazid, tricyclic or tetracyclic antidepressants may also trigger the onset.
Clinical manifestations Epilepsy is mainly divided into two types: generalized seizure status and partial seizure status, among which generalized tonic-clonic seizure status and simple partial motor seizure status are the most common.
Partial-onset seizure continuity Pure partial-motor seizure continuity (Kojevnikov’s epilepsy): a part of the body such as face or mouth twitching, individual fingers or unilateral limbs twitching continuously for hours or days without consciousness impairment may be left with Todd’s palsy at the seizure site after termination of the seizure, or it may extend to secondary generalized seizures. The evolution of the disease depends on the nature of the lesion, and some patients with cryptogenic may not have further seizures after cure; some non-progressive organic lesions may be accompanied by ipsilateral myoclonus later in life, but with a normal EEG background; Rasmussen syndrome (partial continuity epilepsy) presents early with myoclonus and other forms of seizures with progressive diffuse neurological damage manifested. Simple partial sensory seizure continuity is less common clinically
The symptoms include reduced activity, unresponsiveness, sluggishness, loss of concentration, poor orientation, silence or monotone, and nervousness, anxiety, fear, impatience, impulsive behavior, hallucinations, delusions, and wandering for days to months with no memory of the event. It is common in temporal lobe epilepsy and should be distinguished from other causes of mental abnormalities.
The patient is usually conscious and has transient or permanent ipsilateral limb paralysis after the seizure. Infants and children with hemiplegic twitch hemiparesis syndrome (HHS) also present with hemiplegic twitches, often with ipsilateral hemiparesis, and may also develop a persistent state.
The EEG shows focal epileptic discharges in the temporal and frontal lobes.
Seizure continuity in the neonatal period is varied and atypical, mostly with mild jerking, bizarre tonic movements of the limbs, often shifting from one limb to another or hemiplegic jerking, apnea during seizures, unconsciousness EEG shows characteristic abnormalities, 1-4 Hz slow waves interspersed with spikes or 2-6 Hz rhythmic spike and slow wave synthesis, tonic seizures with delta waves, and clonic seizures with spike and sharp wave issuance.
Diagnosis of the condition is based on epilepsy history, clinical features, routine or video EEG examination, etc. Loss of consciousness between seizures is required for the diagnosis of GTCS persistence; partial seizure persistence is seen as partial persistent motor seizures for hours or days without impairment of consciousness; limbic lobe epilepsy persistence and autonomic persistence have impairment of consciousness, which may be accompanied by confusion and no memory afterwards.
Disease examination
Ancillary tests Ancillary tests in patients with status epilepticus should be performed as appropriate under the premise of rapid seizure control.
1.Conventional EEG, video EEG and dynamic EEG monitoring can show epileptic wave patterns such as spike wave, spike wave, spike-slow wave and spike-slow wave, which can help to confirm the diagnosis of seizure and status epilepticus.
2, ECG examination can exclude large myocardial infarction, various types of arrhythmias leading to extensive cerebral ischemia, post-hypoxic seizures and impaired consciousness.
3, Chest X-ray can exclude severe lung infection leading to hypoxemia or respiratory failure.
4. CT and MRI of the head are feasible if necessary.
Prognosis prevention
Prevention of epilepsy is very important. Prevention of epilepsy not only involves the medical field, but also relates to the whole society Prevention of epilepsy should focus on three levels.
First, it is to focus on the cause and prevent the occurrence of epilepsy ;
Second, it is to control seizures;
Third, it is to reduce the adverse physical-psychological and social effects of epilepsy on the patient.
Prevention of the primary cause of symptomatic epilepsy syndrome and early diagnosis and treatment are also important. For those with genetic factors, the importance of genetic counseling should be especially emphasized. A detailed family survey should be conducted to find out whether there are seizures and their characteristics in both parents, siblings and close relatives of the patient. For some serious genetic diseases that can cause mental retardation and epilepsy, prenatal diagnosis or neonatal screening should be performed to decide to terminate the pregnancy or to treat it early.
Definitive diagnosis
(1) Effective treatment requires a correct diagnosis, which should be differentiated from myoclonus, tremor, spasticity, chorea, decerebrate tonicity, and decorticate tonicity.
(2) EEG; blood is drawn and sent for the following laboratory tests: blood pH and blood gas analysis, blood glucose, blood electrolytes, transaminases, blood ketones, blood ammonia, blood white blood cell count and classification, and blood concentration of antiepileptic drugs. Recurrent seizures lasting more than 30 minutes without recovery or each convulsive seizure lasting more than 2 minutes should be considered as persistent status epilepticus.
Caution 1. Avoid smoking, alcohol, tea, coffee, chocolate, Coca-Cola and other foods and beverages containing large amounts of caffeine.
2, watch less television (especially the thrill, fear, excitement, sad film and television programs) do not play chess, do not play cell phones, poker, mahjong, computers, video games.
3, prohibit work at height, even vehicles, operating rotating machinery and often contact with water, fire, electricity, etc..
4, do not overwork, excitement, anger, pay attention to rest.
5, can not suddenly reduce the live stop taking anti-disease drugs, so as not to cause persistent status epilepticus.
6, to overcome inferiority complex and fear, avoid fatigue and tension and other emotional stimulation.
7, to strengthen physical exercise, regular living, avoiding tobacco and alcohol and other stimulating food.
8. Driving and swimming, going out alone at night and other activities are strictly forbidden, and if there are seizure omens, you should immediately lie down to avoid falls.