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Seizures pp 319–331Cite as

Status Epilepticus in the Critically Ill

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Part of the book series: Current Clinical Neurology ((CCP))

Abstract

Status epilepticus (SE) and its subsequent sequelae have been described and documented since the seventh century, B.C. Despite this, it remains a significant medical and public health problem. According to a prospective, population-based study in Richmond, Virginia, a projected 126,000–195,000 cases of SE will occur in the United States each year with 22,000–42,000 resulting in death (1). A retrospective, population-based study in Rochester, Minnesota, showed an age-adjusted incidence of 18.3/100,000, with the greatest incidence in children under 1 yr of age and adults over 60 yr of age (2). The studies mentioned above report that a majority of patients (54%) presenting with SE had no prior history of epilepsy (1,2) and only 18% of unprovoked SE occurred in patients with known epilepsy. There has been an increase in the incidence of SE in patients between 1975 and 1984 (22.4/1000 population) compared to 1965 and 1974 (13.9/1000) (1,2). The majority of this increase is attributable to an increasing incidence in the elderly suffering SE secondary to anoxic encephalopathy, neurologic complications of medical illness, and other severe neurologic insults. Management of these patients poses unique challenges, and we can expect to treat an increasing number of these patients as the population ages and medical technology for the failing organ systems improves. Treatments, whether medical or surgical, carry multiple complication profiles. Other chapters in this book have dealt with specific medical illnesses and their propensity to precipitate seizures.

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References

  1. DeLorenzo RJ, Hauser WA, Towne AR, et al. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology 1996; 45: 1029–1035.

    Article  Google Scholar 

  2. Hesdorffer DC, Logroscino G, Cascino G, Annegers JF, Hauser WA. Incidence of status epilepticus in Rochester, Minnesota, 1965–1984. Neurology 1998; 50: 735–741.

    Article  PubMed  CAS  Google Scholar 

  3. Gastaut H. Clinical and electroencephalographic classification of epileptic seizures. Epilepsia 1970; 11: 102–113.

    Article  PubMed  CAS  Google Scholar 

  4. Proposal for revised clinical and electroencephalographic classification of epileptic seizures from the Commission on Classification and Terminology of the International League against Epilepsy. Epilepsia 1981: 22; 489–501.

    Article  Google Scholar 

  5. Gastaut H, Broughton R. Epileptic Seizures: Clinical and Electrographic Features, Diagnosis and Treatment. Springfield, IL: Charles C. Thomas, 1972, pp 25–90.

    Google Scholar 

  6. Bleck T. Convulsive disorders: status epilepticus. Clin Neuropharmacol 1991; 14: 191–198.

    Article  PubMed  CAS  Google Scholar 

  7. Treiman DM, Meyers, PD, Walton NY, et al. A comparison of four treatments for generalized convulsive status epilepticus. N Engl J Med 1998; 339: 792–798.

    Article  PubMed  CAS  Google Scholar 

  8. Lowenstein DH, Bleck T, MacDonald RL. It’s time to revise the definition of status epilepticus. Epilepsia 1999; 40: 120–122.

    Article  PubMed  CAS  Google Scholar 

  9. Bleck TP, Smith MC, Pierre-Louis SJ-C, Jares JJ, Murray J, Hansen CA. Neurologic complications of critical medical illnesses. Crit Care Med 1993; 21: 98–103.

    Article  PubMed  CAS  Google Scholar 

  10. Waterhouse EJ, Vaughan JK, Barnes TY, et al. Synergistic effect of status epilepticus and ischemic brain injury on mortality. Epilepsy Res 1998; 29: 175–183.

    Article  PubMed  CAS  Google Scholar 

  11. Litt B, Wityk RJ, Hertz SH, Mullen PD, Weiss H, Ryan DD, Henry TR. Nonconvulsive status epilepticus in the critically ill elderly. Epilepsia 1998; 39: 1194–1202.

    Article  PubMed  CAS  Google Scholar 

  12. DeLorenzo RI, Waterhouse ET, Towne AR, et al. Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia 1998; 39: 833–840.

    Article  PubMed  CAS  Google Scholar 

  13. Jaitly R, Sgro JA, Towne AR, Ko D, DeLorenzo RJ. Prognostic value of EEG monitoring after status epilepticus: a prospective adult study. Epilepsia 1997; 14: 326–334.

    CAS  Google Scholar 

  14. Dingledine R, McBain CJ, McNamara JD. Excitatory amino acid receptors in epilepsy. Trends Pharmacol Sci 1990; 11: 334–338.

    Article  PubMed  CAS  Google Scholar 

  15. Lothman E. Biological consequences of repeated seizures In: Engel J Jr, Pedley TA (eds.), Epilepsy: A Comprehensive Textbook. Philadelphia, PA: Lippincott-Raven, 1998, pp 481–497.

    Google Scholar 

  16. Kapur J, Stringer JL, Lothman EW. Evidence that repetitive seizures in the hippocampus cause a lasting reduction of Gabaergic inhibition. J Neurophysiol 1989: 61; 417–426.

    PubMed  CAS  Google Scholar 

  17. Meldrum B. Excitotoxicity and epileptic brain damage. Epilepsy Res 1991; 10: 55–61.

    Article  PubMed  CAS  Google Scholar 

  18. Meldrum BS. Excitoxicity and selective neuronal loss in epilepsy. Brain Pathol 1993; 3: 405–412.

    Article  PubMed  CAS  Google Scholar 

  19. Rice AC, DeLorenzo RJ. NMDA receptor activation during status epilepticus is required for the development of epilepsy. Brain Res 1998; 782: 240–247.

    Article  PubMed  CAS  Google Scholar 

  20. Meldrum BS. Metabolic factors during prolonged seizures and their relation to insure cell death. In: Delgado-Escueta AV, Wasterman CC, Treiman DM, Pater RJ (eds.), Status Epilepticus: Mechanism of Brain Damage and Treatment New York: Raven, 1983, pp 261–275. Advances in Neurology, vol. 34.

    Google Scholar 

  21. Benowitz NL, Simon RP, Copeland JR. Status epilepticus: divergence of sympathetic activity and cardiovascular response. Ann Neurol 1986; 19: 197–199.

    Article  PubMed  CAS  Google Scholar 

  22. Aminoff MJ, Simon RP. Status epilepticus causes, clinical features and consequences in 98 patients. Am J Med 1980; 69: 657–666.

    Article  PubMed  CAS  Google Scholar 

  23. Bayne LL, Simon RP. Systemic and pulmonary vascular pressure during generalized seizures in sleep. Ann Neurol 1981; 10: 566–569.

    Article  PubMed  CAS  Google Scholar 

  24. Winocour PH, Waise A, Young G, Moriarity KJ. Severe self-limiting lactic acidosis and rhabdomyolysis accompanying convulsions. Postgrad Med J 1989; 65: 321–323.

    Article  PubMed  CAS  Google Scholar 

  25. Minns RA. Intracranial pressure changes associated with childhood seizures. Dev Med Child Neurol 1978; 20: 561–569.

    Article  PubMed  CAS  Google Scholar 

  26. Lukovits TG, Smith MC. Update on status epilepticus. Curr Opin Crit Care 1999; 5: 107–111.

    Article  Google Scholar 

  27. Browne T. Fosphenytoin. Clin Neuropharmacol 1997; 20: 1–12.

    Article  PubMed  CAS  Google Scholar 

  28. Ramsey RE, Wilder BJ. Parenteral fosphenytoin: efficacy and economic considerations. Neurologist 1998;4:S30–S34

    Google Scholar 

  29. Koh HS, Hulihan JF. Intravenous valproic acid for acute inpatient seizure treatment. Epilepsia 1998;39(Suppl 6):S128 (abstract).

    Google Scholar 

  30. Mueed S, Naritoku DK. Intravenous loading and replinshment therapy with valproic acid (VPA). Epilepsia 1998; 39 (Suppl 6): S128 (abstract).

    Google Scholar 

  31. Lowe MR, DeToledo, JC, Vilavizza N, Ramsay RE. Efficacy, safety and tolearability of fast IV loading of valproate in patients with seizures and status epilepticus. Epilepsia 1998;39(Suppl 6):5235 (abstract).

    Google Scholar 

  32. Harrison AM, Lugo RA, Schunk JE. Treatment of convulsive status epilepticus with propofol case report. Pediatr Emerg Care 1997; 13: 420–422.

    Article  PubMed  CAS  Google Scholar 

  33. Kendall JL, Reynolds M, Goldberg R. Intranasal midzolam in patients with status epilepticus. Ann Emerg Med 1997; 29: 415–417.

    Article  PubMed  CAS  Google Scholar 

  34. Scott RC, Besag FM, Neville BG. Buccal midazolam or rectal diazepam for the acute treatment of seizures? Epilepsia 1998; 39 (Suppl 6): 235.

    Google Scholar 

  35. Scott RC, Besad FMC, Boyd SG, Berry D, Neveille BGR. Buccal absorption of midazolam: pharmacokinetics and EEG pharmacodynamics Epilepsia 1998; 39: 290–294.

    Article  PubMed  CAS  Google Scholar 

  36. Stecker MM, Kramer TH, Rapps C, O’Meeghan R, Dulaney E, Skaar DJ. Treatment of refractory status epilepticus with propofol: clinical and pharmacokinetic findings. Epilepsia 1998; 39: 18–26.

    Article  PubMed  CAS  Google Scholar 

  37. Croutea D, Shevell M, Rosenblatt B, Dilenge M-E, Andermann F. Treatment of absence status in the Lennox-Gastaut syndrome with propofol. Neurology 1998; 51: 315–316.

    Article  Google Scholar 

  38. Brown LA, Leven GM. Role of propofol in refractory status epilepticus. Ann Pharmacother 1998; 32: 1053–1059.

    Article  PubMed  CAS  Google Scholar 

  39. Hauser WA. Status epilepticus, frequency etiology and neurological sequelae. In: Delgado-Escueta AV, Wasterman CG, Treiman DM, et al. (eds.), Status Epilepticus: Advances in Neurology, New York: Raven, 1983, pp 3–14.

    Google Scholar 

  40. Simon R, Pellock JM, DeLorenzo RJ. Acute morbidity and mortality of status epilepticus. In: Engel J Jr, Pedley TA (eds.), Epilepsy: A Comprehensive Textbook, Philadelphia, PA: Lippincott-Raven, 1998, pp 741–753.

    Google Scholar 

  41. Aicardi J, Baraton J. A pneumoencephalographic demonstration of brain atrophy following status epilepticus. Dev Med Child Neurol 1971; 15: 77–81.

    Article  Google Scholar 

  42. Dodrill CB, Wilensky AJ. Intellectual impairment as an outcome of status epilepticus. Neurology 1990; 40 (Suppl 2): 23–27.

    PubMed  CAS  Google Scholar 

  43. Falconer MA. Serafetinides EA, Corsellis JAN. Etiology and pathogenesis of temporal lobe epilepsy. Arch Neurol 1964; 10: 233–248.

    Article  PubMed  CAS  Google Scholar 

  44. Fowler M. Brain damage after febrile convulsion. Arch Dis Child 1957; 32: 67–76.

    Article  PubMed  CAS  Google Scholar 

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Authors
  1. Michael C. Smith MD
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  2. Michele Del Signore DO
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Editor information

Editors and Affiliations

  1. Department of Clinical Neurological Sciences, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland

    Norman Delanty MB, FRCPI (Consultant Neurologist) (Consultant Neurologist)

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Smith, M.C., Del Signore, M. (2002). Status Epilepticus in the Critically Ill. In: Delanty, N. (eds) Seizures. Current Clinical Neurology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-094-0_20

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  • DOI: https://doi.org/10.1007/978-1-59259-094-0_20

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61737-207-0

  • Online ISBN: 978-1-59259-094-0

  • eBook Packages: Springer Book Archive

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