Generalized Convulsive Status Epilepticus

  • J. M. K. Murthy


Status epilepticus (SE) is a common neurological emergency associated with high morbidity and mortality [1]. SE is broadly classified based solely on the presence or absence of convulsions into convulsive SE (CSE) and nonconvulsive SE (NCSE). Early institution of appropriate treatment is associated with good outcomes.


  1. 1.
    Fountain NB. Status epilepticus: risk factors and complications. Epilepsia. 2000;41:S23–30.CrossRefGoogle Scholar
  2. 2.
    Chin RFM, Neville BGR, Scott RC. A systematic review of the epidemiology of status epilepticus. Eur J Neurol. 2004;11:800–10.CrossRefGoogle Scholar
  3. 3.
    DeLorenzo RJ, Hauser WA, Towne AR, et al. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology. 1996;46:1029–35.CrossRefGoogle Scholar
  4. 4.
    Hesdorffer DC, Logroscino G, Cascino G, Annegers JF, Hauser WA. Incidence of status epilepticus in Rochester, Minnesota, 1965–1984. Neurology. 1998;50:735–41.CrossRefGoogle Scholar
  5. 5.
    Logroscino G, Hesdorff DC, Cascino G, Annegers JF, Hauser WA. Time trends in incidence, mortality, and case-fatality after first episode of status epilepticus. Epilepsia. 2001;42:1031–5.CrossRefGoogle Scholar
  6. 6.
    Coeytaux A, Jallon P, Galobardes B, Morabia A. Incidence of status epilepticus in French-speaking Switzerland: (EPISTAR). Neurology. 2000;55:693–7.CrossRefGoogle Scholar
  7. 7.
    Knake S, Rosenow F, Vescovi M, et al. Incidence of status epilepticus in adults in Germany: a prospective, population-based study. Epilepsia. 2001;47:714–8.CrossRefGoogle Scholar
  8. 8.
    Rossetti AO, Logroscino G, Bromfield EB. Refractory status epilepticus: effect of treatment aggressiveness on prognosis. Arch Neurol. 2005;62:1698–702.CrossRefGoogle Scholar
  9. 9.
    Al-Mufti F, Claassen J. Neurocritical care—status epilepticus review. Crit Care Clin. 2014;30:751–64.CrossRefGoogle Scholar
  10. 10.
    Trinka E, Cock H, Hesdorffer D, et al. A definition and classification of status epilepticus—report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia. 2015;56:1515–23.CrossRefGoogle Scholar
  11. 11.
    Kapur J, Macdonald RL. Rapid seizure-induced reduction of benzodiazepine and Zn2+ sensitivity of hippocampal dentate granule cell GABAA receptors. J Neurosci. 1997;17:7532–40.CrossRefGoogle Scholar
  12. 12.
    Jones DM, Esmaeil N, Maren S, Macdonald RL. Characterization of pharmacoresistance to benzodiazepines in the rat Li-pilocarpine model of status epilepticus. Epilepsy Res. 2002;50:301–12.CrossRefGoogle Scholar
  13. 13.
    DeLorenzo RJ, Waterhouse EJ, Chum F, et al. Persistent nonconvulsive status epilepticus after control of convulsive status epilepticus. Epilepsia. 1998;39:833–40.CrossRefGoogle Scholar
  14. 14.
    Brophy GM, Bell R, Claassen J, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17:3–23.CrossRefGoogle Scholar
  15. 15.
    Berg AT, Berkovic SF, Brodie MJ, et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005–2009. Epilepsia. 2010;51:676–85.CrossRefGoogle Scholar
  16. 16.
    Foreman B, Hirsch LJ. Epilepsy emergencies: diagnosis and management. Neurol Clin. 2012;30:11–41.CrossRefGoogle Scholar
  17. 17.
    DeLorenzo RJ, Pellock JM, Towne AR, Boggs JG. Epidemiology of status epilepticus. J Clin Neurophysiol. 1995;12:316–25.CrossRefGoogle Scholar
  18. 18.
    Lowenstein DH, Alldredge BK. Status epilepticus at an urban public hospital in the 1980s. Neurology. 1993;43:483–8.CrossRefGoogle Scholar
  19. 19.
    Garzon E, Fernandez RM, Sakamoto AC. Analysis of clinical characteristics and risk factors for mortality in human status epilepticus. Seizure. 2003;12:337–45.CrossRefGoogle Scholar
  20. 20.
    Misra UK, Kalita J, Patel R. Sodium valproate vs. phenytoin in status epilepticus: a pilot study. Neurology. 2006;67:340–2.CrossRefGoogle Scholar
  21. 21.
    Murthy JMK, Jayalaxmi SS, Kanikannan MA. Convulsive status epilepticus: clinical profile in a developing country. Epilepsia. 2007;48:2217–23.PubMedGoogle Scholar
  22. 22.
    Shorvon S. Definition, classification and frequency of status epilepticus. In: Shorvon S, editor. Status epilepticus, its clinical features and treatment in children and adults. Cambridge: Cambridge University Press; 1994. p. 21–30.CrossRefGoogle Scholar
  23. 23.
    Shorvon S, Ferlisi M. The treatment of super-refractory status epilepticus: a critical review of available therapies and a clinical treatment protocol. Brain. 2011;134:2802–18.CrossRefGoogle Scholar
  24. 24.
    Trinka E, Hofler J, Leitinger M, Brigo F. Pharmacotherapy for status epilepticus. Drugs. 2015;75:1499–521.CrossRefGoogle Scholar
  25. 25.
    Silbergleit R, Durkalshki V, Lowenstein D, et al. Intramuscular versus intravenous therapy for prehospital status epilepticus. N Engl J Med. 2012;366:591–600.CrossRefGoogle Scholar
  26. 26.
    Trinka E, Kalviainen R. 25 years of advances in definition, classification and treatment of status epilepticus. Seizure. 2017;44:65–73. Scholar
  27. 27.
    Yasiry Z, Shorvon SD. The relative effectiveness of five antiepileptic drugs in treatment of benzodiazepine-resistant convulsive status epilepticus: a meta-analysis of published studies. Seizure. 2014;23:167–74.CrossRefGoogle Scholar
  28. 28.
    Rossetti AO, Lowenstein DH. Management of refractory status epilepticus in adults: still more questions than answers. Lancet Neurol. 2011;10:922–30.CrossRefGoogle Scholar
  29. 29.
    Holtkamp M, Othman J, Buchheim K, Meierkord H. Predictors and prognosis of refractory status epilepticus treated in a neurological intensive care unit. J Neurol Neurosurg Psychiatry. 2005;76:534–9.CrossRefGoogle Scholar
  30. 30.
    Mayer SA, Claassen J, Lokin J, Mendelsohn F, Dennis LJ, Fitzsimmons BF. Refractory status epilepticus: frequency, risk factors, and impact on outcome. Arch Neurol. 2002;59:205–10.CrossRefGoogle Scholar
  31. 31.
    Garzon E, Fernandez RM, Sakamoto AC. Analysis of clinical characteristics and risk factors for mortality in human status epilepticus. Seizure. 2003;12:337–45.CrossRefGoogle Scholar
  32. 32.
    Herman ST, Abend NS, Bleck TP, et al. Consensus statement on continuous EEG in critically ill adults and children, Part I: indications. J Clin Neurophysiol. 2015;32:87–95.CrossRefGoogle Scholar
  33. 33.
    Meldrum BS. Excitotoxicity and epileptic brain damage. Epilepsy Res. 1991;10:55–61.CrossRefGoogle Scholar
  34. 34.
    Kapur J, Macdonald RL. Rapid seizure-induced reduction of benzodiazepine and Zn21 sensitivity of hippocampal dentate granule cell GABAA receptors. J Neurosci. 1997;17:7532–40.CrossRefGoogle Scholar
  35. 35.
    Rossetti AO. Which anesthetic should be used in the treatment of refractory status epilepticus? Epilepsia. 2007;48(Suppl 8):52–5.CrossRefGoogle Scholar
  36. 36.
    Claassen J, Hirsch LJ, Emerson RC, et al. Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: a systematic review. Epilepsia. 2002;43:146–53.18.CrossRefGoogle Scholar
  37. 37.
    Horn P, Oddo M, Schmitt SE. Electroencephalography. In: Le Roux DP, Levine MJ, Kofke WR, editors. Monitoring in neurocritical care. Philadelphia: Elsevier Sunders; 2014. p. 246–56.Google Scholar
  38. 38.
    Kowalski RC, Ziai WC, Rees RN, et al. Third-line antiepileptic therapy and outcome in status epilepticus: the impact of vasopressor use and prolonged mechanical ventilation. Crit Care Med. 2012;40:2677–84.CrossRefGoogle Scholar
  39. 39.
    Sutter R, Marsh S, Fuhr P, Kaplan PW, Ruegg S. Anesthetic drugs in status epilepticus—risk or rescue? A six-year cohort study. Neurology. 2013;82:656–64.CrossRefGoogle Scholar
  40. 40.
    Marchi NA, Novy J, Faouzi M, Stahli C, Burnand B, Rossetti AO. Status epilepticus: impact of therapeutic coma on outcome. Crit Care Med. 2015;43:1003–9.CrossRefGoogle Scholar
  41. 41.
    Sutter R, Kaplan PE. Can anesthetic treatment worsen outcome in status epilepticus? Epilepsy Behav. 2015;49:294–7.CrossRefGoogle Scholar
  42. 42.
    Alvarez V, Lee JW, Westover MB, et al. Therapeutic coma for status epilepticus: differing practices in a prospective multicenter study. Neurology. 2016;87:1650–9.CrossRefGoogle Scholar
  43. 43.
    Cuero MR, Varelas PN. Super-refractory status epilepticus. Curr Neurol Neurosci Rep. 2015;15:74.CrossRefGoogle Scholar
  44. 44.
    Tian L, Li Y, Xue X, et al. Super-refractory status epilepticus in West China. Acta Neurol Scand. 2015;132:1–6.CrossRefGoogle Scholar
  45. 45.
    Martin B, Kapur J. A combination of ketamine and diazepam synergistically controls refractory status epilepticus induced by cholinergic stimulation. Epilepsia. 2008;49:248–55.CrossRefGoogle Scholar
  46. 46.
    Hsieh C, Sung PS, Tsai JJ, et al. Terminating prolonged refractory status epilepticus using ketamine. Clin Neuropharmacol. 2010;33:165–7.CrossRefGoogle Scholar
  47. 47.
    Sabharwal V, Ramsay E, Martinez R, et al. Propofol-ketamine combination therapy for effective control of super-refractory status epilepticus. Epilepsy Behac. 2015;52:264–6.CrossRefGoogle Scholar
  48. 48.
    Fang Y, Wang X. Ketamine for treatment of refractory status epilepticus. Seizure. 2015;30:14–20.CrossRefGoogle Scholar
  49. 49.
    Borris DJ, Bertram EH, Kapur J. Ketamine controls prolonged status epilepticus. Epilepsy Res. 2000;42:117–22.CrossRefGoogle Scholar
  50. 50.
    Zeiler FA, Teitelbaum J, Gillman LM, West M. NMDA antagonists for refractory seizures. Neurocrit Care. 2014;20:502–13.CrossRefGoogle Scholar
  51. 51.
    Wusthoff CJ, Kranick SM, Morley JF, Christina Bergqvist AG. The ketogenic diet in treatment of two adults with prolonged nonconvulsive status epilepticus. Epilepsia. 2010;51:1083–5.CrossRefGoogle Scholar
  52. 52.
    Thakur KR, Probasco JC, Hocker SE, et al. Ketogenic diet for adults in super-refractory status epilepticus. Neurology. 2014;82:665–70.CrossRefGoogle Scholar
  53. 53.
    Khawaja AM, DeWolfe JL, Miller DW, Szaflarski JP. New-onset refractory status epilepticus (NORSE)—the potential role for immunotherapy. Epilepsy Behav. 2015;47:17–23.CrossRefGoogle Scholar
  54. 54.
    Lopinto-Khouey C, Sperling MR. Autoimmune status epilepticus. Curr Treat Options Neurol. 2013;15:545–56.CrossRefGoogle Scholar
  55. 55.
    Wijidicks EFM. The multifaceted care of status epilepticus. Epilepsia. 2013;54(Suppl 6):61–3.CrossRefGoogle Scholar
  56. 56.
    Hocker S. Systemic complications of status epilepticus—an update. Epilepsy Behav. 2015;49:83–7.CrossRefGoogle Scholar
  57. 57.
    Alldredge BK, Gelb AM, Isaacs SM, et al. A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital statue epilepticus. N Engl J Med. 2001;345:631–7.CrossRefGoogle Scholar
  58. 58.
    Novy J, Logroscino G, Rossetti AO. Refractory status epilepticus: a prospective observational study. Epilepsia. 2010;51:251–6.CrossRefGoogle Scholar
  59. 59.
    Claassen J, Lokin JK, Fitsimmons BF, et al. Predictors of functional disability and mortality after status epilepticus. Neurology. 2002;58:139–42.CrossRefGoogle Scholar
  60. 60.
    Treiman DM, Meyers PD, Walton NY, et al. A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med. 1998;339:792–8.CrossRefGoogle Scholar
  61. 61.
    Kantanen AM, Reinikainen M, Parvianen L, et al. Incidence and mortality of super-refractory status epilepticus in adults. Epilepsy Behav. 2015;49:131–4.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2019

Authors and Affiliations

  • J. M. K. Murthy
    • 1
  1. 1.Department of NeurologyCARE Institute of Neurosciences, CARE Outpatient Centre, CARE HospitalsHyderabadIndia

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