4):127138, 2012
doi: 10.1111/j.1528-1167.2012.03622.x
SUMMARY
Status epilepticus (SE) is the most extreme form
of epilepsy. It describes a prolonged seizure that
may occur in patients with previous epilepsy or in
acute disorders of the central nervous system. It is
one of the most common neurologic emergencies,
with an incidence of up to 41 per 100,000 per year
and an estimated mortality is 20%. The three
major determinants of prognosis are the duration
of SE, patient age, and the underlying cause. Common and easily recognized causes of SE include
cerebrovascular disorders, brain trauma, infections, and low antiepileptic drug levels in patients
Status epilepticus (SE) is a term used to describe a prolonged and self-sustaining seizure that may have overt,
subtle, or almost no behavioral manifestations. It may be
regarded as the most extreme form of epilepsy, or as an
expression of an acute and often life-threatening brain disorder, such as stroke, encephalitis, or trauma. Mortality
associated with SE is up to 20% (Shorvon, 1994; Logroscino
et al., 1997, 2005). Less than 50% of people in SE have
had previous seizures or epilepsy (DeLorenzo et al., 1996;
Hesdorffer et al., 1998; Coeytaux et al., 2000; Knake
et al., 2001; Vignatelli et al., 2003). SE is one of the most
common neurologic emergency, with an overall annual
incidence of 1041 per 100,000 (DeLorenzo et al., 1996;
Hesdorffer et al., 1998; Coeytaux et al., 2000; Knake
et al., 2001; Vignatelli et al., 2003). Up to 287,000 patients
per year are affected in Europe. Not all forms of status are
life-threatening and, given the variety of its clinical presentations, the management must be tailored according to
the type of SE and the underlying cause. Three major
factors determine an increased risk of mortality and morbidity associated with SE: (1) certain etiologies, (2) age
with epilepsy. Less common causes present a clinical and diagnostic challenge, but are major determinants of prognosis. Among them, inflammatory
causes and inborn errors of metabolism have
gained wide interest; recent insights into these
causes have contributed to a better understanding
of the pathophysiology of SE and its appropriate
treatment. This review focuses on the different
etiologies of SE and emphasizes the importance of
prompt recognition and treatment of the underlying causes.
KEY WORDS: Status epilepticus etiology, Treatment, Prognosis.
127
128
E. Trinka et al.
along two taxonomic criteria: the presence (or absence) of
motor symptoms and the impairment (or retention) of consciousness. Therefore, one can distinguish (A) SE types
with prominent motor symptoms, such as convulsive SE,
and (B) SE types without prominent motor symptoms,
summarized as nonconvulsive SE (NCSE). NCSE can
occur with or without coma; this has important etiologic
implications and determines its treatment. A third category (C) comprises the boundary syndromes, including
epileptic encephalopathies and acute forms of coma with
status-like electroencephalography (EEG) patterns.
Table 1 briefly outlines this tentative classification. For a
more detailed discussion of SE classification, refer to:
(Shorvon, 1994; Walker et al., 2005; Bauer & Trinka,
2006, 2009; Berg et al., 2010). However, the definitions
and classifications are in flux and an ILAE Task force is
currently developing a new draft classification of SE, following the concepts of the ILAEs new classification proposal of seizures and syndromes (Berg et al., 2010).
Figure 1.
Etiology of status epilepticus in adults, with associated
mortality for each category. Based on data from
DeLorenzo et al., 1995. AED, antiepileptic drugs; CNS,
central nervous system.
Epilepsia ILAE
129
Causes of Status Epilepticus
However, the precise incidence of convulsive status or
myoclonic status in these syndromes is not known.
Approximately 12% of patients who eventually develop
epilepsy have presented with SE as their first clinical manifestation (Hauser, 1990; Hesdorffer et al., 1998). In these
patients, SE may be an intrinsic manifestation of disease,
sometimes with recurrent episodes, or the epilepsy may be
the consequence of a prolonged SE, with neuronal death
and alteration of networks causing recurrent seizures after
the initial event. During a 10-year follow-up, epilepsy
developed in 42% of patients who had acute symptomatic
SE and in 14% of patients who had acute symptomatic
seizures (Hesdorffer et al., 1998). The development of
subsequent epilepsy is more likely if the status is refractory to treatment (Holtkamp et al., 2005), supporting the
hypothesis that SE contributes to epileptogenesis by
enhancing hyperexcitable networks.
Nonconvulsive Status
Epilepticus
NCSE may be defined as an enduring epileptic condition with reduced or altered consciousness, behavioral and
vegetative abnormalities, or merely subjective symptoms
without major convulsive movements (Drislane, 2000).
This umbrella term includes a wide spectrum of disorders,
ranging from benign conditions, such as absence status in
idiopathic generalized epilepsy, to severe life-threatening
conditions, such as subtle SE or coma with generalized
epileptiform discharges (coma-GEDs). Therefore, it is
important to subdivide this category according to the
degree of unresponsiveness or to the depth of coma
(Fig. 2). Consciousness, which notoriously resists definition, becomes a taxonomic criterion for subdividing
NCSE (Bauer & Trinka, 2009). Consciousness itself can
be categorized into quantitative and qualitative consciousness. The quantitative element depends upon the patients
level of consciousness and arousability, which in turn
depends upon the integrity of the ponto-mesodiencephalic
reticular pathways and the thalamocortical projections.
Qualitative consciousness, on the other hand, depends
upon the content of consciousness, experience, emotions,
and sensations, known only to patients themselves. It
reflects the inner monologue and it is essential for any
meaningful interaction with the environment. Qualitative
consciousness is associated with awareness, enabling the
patient either to focus on and interact with the environment or to engage in an inner monologue. Table 2
describes the different types of NCSE.
The incidence of NCSE, based on epidemiologic studies, ranges from 40.0 to 66.9% (DeLorenzo et al., 1995;
Hesdorffer et al., 1998; Coeytaux et al., 2000; Knake
et al., 2001; Vignatelli et al., 2003). Like convulsive status, NCSE may occur in acute central nervous system
(CNS) disorders or may be a part of certain electroclinical
Figure 2.
Relationship between depth and coma (x-axis), prognosis (x-axis), degree of structural brain damage (red yaxis), and epileptic brain dysfunction (blue y-axis) due
to status epilepticus. Clinical entities depicted in the
upper part of the graph are arranged along the x-axis
without distinct positions, in recognition that large
border zones and overlaps between the conditions
may exist. With permission from Bauer & Trinka, 2009.
AS, absence status epilepticus; EPC, epilepsia partialis
continua; GEDs, generalized epileptiform discharges;
IGE, idiopathic generalized epilepsy; LEDs, lateralized
epileptiform discharges; NCSE, nonconvulsive status
epilepticus.
Epilepsia ILAE
130
E. Trinka et al.
Table 3. Types of NCSE in 220 patients with
epilepsy and a history of NCSE (Bauer &
Trinka, data on file)
Generalized (106 = 48.2%)
Typical absence SE
Atypical absence SE
Localized/lateralized (100 = 45.5%)
Focal simple (58 = 26.4%)
Aura continua
Vegetative
Aphasic
Pure frontal
Psychosis
Focal complex (42 = 19.1%)
Continuous
Discontinuous
Unclassified
Total
57
49
25.9
22.3
11
8
27
9
3
5.0
3.6
12.3
4.1
1.4
30
12
14
220
13.7
5.5
6.3
100.1
Figure 3.
Typical absence status epilepticus in an older patient (V.J., female, 74 years. tc 0.3 F30). This patient had scattered
generalized tonicclonic seizures since age of 54 years. Her EEG showed periodically repeated generalized 3/s spike
and wave, with no major diffuse slow activity between periods (note the reduced time calibration). EEG kindly
provided by Prof. Dr. G. Bauer, Innsbruck. The patient displayed discontinuous psychic functions, and was amnesic
for the abnormal condition. Recovery was immediate after intravenous diazepam.
Epilepsia ILAE
Epilepsia, 53(Suppl. 4):127138, 2012
doi: 10.1111/j.1528-1167.2012.03622.x
131
Causes of Status Epilepticus
patients develop AS later in life, occasionally de novo
(Andermann & Robb, 1972; Thomas et al., 1992), or it
may occur as a late exacerbation of an idiopathic generalized epilepsy syndrome (Bauer et al., 2007). There may
also be a fourth group of AS, comprising absences with
very clear focal characteristics. This group may be considered as a transitional form between AS and dyscognitive
focal SE of frontal origin (Bauer et al., 2006; Thomas,
2011).
Many cases of AS have nonspecific precipitating factors. The most important are antiepileptic drug (AED)
withdrawal or impaired adherence, alcohol, sleep deprivation, and sleepwake cycle disturbance. Other nonspecific
factors include stress, fatigue, fever, mild head trauma, or
metabolic derangement after surgery (Thomas & Zifkin,
2008; Thomas & Gelisse, 2009).
Several idiopathic generalized epilepsy syndromes may
be aggravated by inappropriate AEDs: carbamazepine,
phenytoin, tiagabine, or other c-aminobutyric acid
(GABA)ergic medications (Snead & Hosey, 1985; Knake
et al., 1999; Thomas et al., 2006a,b; Trinka et al., 2002).
Thomas et al. reported 14 patients with idiopathic generalized epilepsy treated with either carbamazepine alone or
with other potentially aggravating drugs, for example,
phenytoin, vigabatrin, or gabapentin. Ten of these cases
developed AS; in half, the AS was atypical. All their
patients had a clear seizure aggravation, with development
of new seizure types before AS developed (Thomas et al.,
2006a,b). The prognosis was invariably good with full seizure control in all patients after switching to appropriate
drugs.
In late-onset AS, other drug-related factors play an
important clinical role (Thomas et al., 1992; Thomas &
Andermann, 1994). Most importantly, psychotropic medicationor its withdrawalmay provoke late-onset AS
(Fernandez-Torre, 2001). In addition, many other drugs,
for example, theophylline, baclofen, metformin, and
cimetidine, may exacerbate absences later in life (for a
review see Thomas & Snead, 2007).
There are metabolic and toxic factors in many patients,
although the precise incidence is not known. Examples
include hyponatremia, hypoglycemia decompensated
chronic renal failure, hepatic failure, and hypocalcemia
(for review see Thomas & Snead, 2007). There have been
several cases of AS following the use of contrast-enhancing products during myelography or carotid angiography
(Pritchard & ONeil, 1984; Vollmer et al., 1985; Coeytaux
et al., 2000). Some cases of transient global amnesia after
angiography may in fact also be epileptic in nature (Bauer
et al., 2005).
AS probably occurs most frequently in the context of
electroclinical syndromes. Aside from childhood
absence epilepsy, juvenile absence epilepsy, and juvenile myoclonic epilepsy, there are other syndromes associated with AS as a key clinical feature: AS may occur
Figure 4.
Clinical course of convulsive status epilepticus.
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doi: 10.1111/j.1528-1167.2012.03622.x
132
E. Trinka et al.
lesion. The etiology was most often a brain tumor (benign
or malignant), or a posttraumatic or a postsurgical lesion
(Thomas & Zifkin, 2008).
Rare causes of focal NCSE include intravenous contrast
media, or drugs such as ciprofloxacin, lithium intoxication, theophylline, vigabatrin, tiagabine, or crack cocaine
(Thomas et al., 2006b). Mesial temporal focal NCSE can
also be the presenting symptom of the increasingly recognized nonparaneoplastic limbic encephalitis, related to
voltage-dependent potassium channels (VGKC/LGI1)
(Irani et al., 2010), NMDA receptors (Vincent & Bien,
2008), or antibodies against glutamic acid decarboxylase
(Malter et al., 2010). Some of them lead to a specific seizure type (e.g., faciobrachial dystonic seizures associated
with anti-VGKC/LGI1 antibodies), preceding the onset of
the limbic encephalitis (Irani et al., 2011a,b). It is important to note that paraneoplastic limbic encephalitis may
also present with focal NCSE (Dalmau et al., 2008), indicating the need for a comprehensive search and rigorous
treatment of any underlying primary neoplasm. We do not
yet know the full spectrum of this new group of immunemediated encephalopathies (Table 4).
The outcome for focal NCSE is less favorable than that
for AS. Long-lasting focal status, especially of temporal
lobe origin, may cause brain edema identifiable on magnetic resonance imaging (MRI) (Bauer et al., 2006). These
patients may also have severe and prolonged amnesia
(Engel et al., 1978; Treiman et al., 1981). However, many
patients presenting with focal NCSE have acute or remote
symptomatic epileptogenic lesions, making it difficult to
disentangle the dysfunction due to the epileptic activity
from the effect of the structural lesion (Hilkens & De
Weerd, 1995; Kaplan, 1996; Trinka et al., 2002). However, focal NCSE occurring with an acute lesion most
likely contributes substantially to the associated neurologic dysfunction (Hilkens & De Weerd, 1995; Bauer &
Trinka, 2010). Therefore, patients with focal NCSE need
prompt and vigorous treatment, tailored to the underlying
cause.
Causes of Comatose
Nonconvulsive Status
Epilepticus
Comatose forms of NCSE need further attention. It is
important from the clinical standpoint (1) to clarify
whether the coma is caused by the epileptic seizure or status, or by the brain disorder itself, (2) to assess the contribution of epileptic activity to the depth of coma, (3) to
consider whether treatment improves prognosis in these
patients or not, and (4) to implement an appropriate treatment in these critically ill patients. Unlike in other forms
of NCSE, the cause of the comatose patients SE can
sometimes only be identified from the history, the temporal pattern of coma, and the neurologic signs. The epileptic
etiology is most often confirmed only by the presence of
continuous or discontinuous epileptiform discharges on
the EEG (Lowenstein & Aminoff, 1992; Jordan, 1999;
Brenner, 2005). A frequently used, but not universally
accepted, classification of patients in comatose status uses
the dichotomy of generalized versus focal or lateralized
EEG discharges (Brenner, 2004). The EEG is absolutely
necessary to make this distinction. In this review we used
the terms coma with generalized epileptiform discharges (or coma-GED) and coma with lateralized epileptiform discharges (or coma-LED) (Bauer & Trinka,
2009). The etiology in these patients is almost always
acute symptomatic, encompassing a wide variety of
coma LED
Etiology
EEG pattern
Diffuse primary or
secondary brain
disturbances (anoxic,
toxic, metabolic,
infectious, degenerative)
Space-occupying lesions
with brainstem
compression (direct or
due to tentorial
herniation)a
Known epilepsies?
Focal brain lesions (in
most cases acutely
acquired) In rare cases
diffuse abnormalities
(aminophylline,
intoxiation, some forms
of diabetic coma)
Known epilepsies?
Continuous generalized
spiking
Periodic spiking
Burst suppression pattern
in different variations
Other generalized
periodic abnormalities
Bilateral triphasic waves
133
Causes of Status Epilepticus
Table 6. Causes of epilepsia partialis continua (according to Tan et al., 2010)
EPC type 1 (static cause)
Infancy
Hemimegalencephaly
Mitochondrial disease
(Alper disease)
Childhood
Rasmussen syndrome
Adults
Diagnostic test
Age period
Repeated skin
examination
Neurocysticerosis
Immunoelectrotransfer
blot assay
(Tick-borne) encephalitis
Gliomatosis cerebri
Other foreign tissue
lesions Nonketotic
(ketotic) hyperglycemia
Cerebrovascular
disorders (stroke;
intracranial bleeding,
cerebral venous
thrombosis, vasculitis)
Nonketotic (ketotic)
hyperglycemia
Focal cortical dysplasia
Paraneoplastic limbic
encephalopathy
Neoplasms
Tuberculous meningitis
(tuberculoma)
(Tick-borne) encephalitis
Autoimmune thyroid
encephalopathy
Behcet disease
Sjogren syndrome
Multiple sclerosis
HIV encephalopathy
Serum glucose
Diagnostic test
Serum and cerebrospinal
fluid lactate, muscle
biopsy biopsy,
mitochondrial DNA
(mutation of POLG1)
Cerebrospinal fluid
oligoclonal banding,
immunoglobulin G index
Mitochondrial
encephalomyopathy, lactic
acidosis and stroke-like episodes
(MELAS)
Delayed type of measles
encephalitis (complication of
measles in
immunocompromised children)
Adult-onset Rasmussens
syndrome
Cerebrospinal fluid
oligoclonal banding,
immunoglobulin G index
Creutzfeldt-Jakob disease
14-3-3 protein in
cerebrospinal fiuid
Serum and cerebrospinal
fluid lactate, muscle
biopsy, mitochondrial
DNA
Skin or rectal mucosal
biopsy
Kufs disease
134
E. Trinka et al.
systemic diseases or CNS disorders. Table 5 shows the etiologic factors and EEG patterns found in coma-GED and
coma-LED. Unlike in AS and focal NCSE, these patients
are often resistant to treatment, and the prognosis depends
entirely on the course of the underlying disorder.
Advanced convulsive SE becomes oligosymptomatic with
fewer motor symptoms; deep coma is the leading symptom, hence the term subtle status (Treiman et al., 1984).
The causes are identical to convulsive SE.
disorders, with age of onset ranging from infancy to adulthood, and even in the elderly. The prevalence, based on
the EPC case registry of the British Neurological Surveillance Unit, is <1 per million (Cockerell et al., 1996).
The reported causes of EPC are extremely diverse, and
include metabolic disorders (nonketotic hyperglycemia or
mitochondrial encephalopathy), cerebrovascular disorders, inflammation (especially CreutzfeldtJakob disease,
progressive multifocal leukoencephalopathy from HIV
infection, multiple sclerosis, neurocysticercosis and others), neoplasms (astrocytoma, hemangioma, lymphoma
and metastasis), and cortical dysplasia (focal cortical
dysplasia and hemimegalencephaly) (Oguni et al., 1991;
Veggiotti et al., 1995; Lee et al., 2000; Placidi et al., 2001;
Pandian et al., 2002; Huang et al., 2005; Wieser & Chauvel,
2005; Aydin-Ozdemir et al., 2006; Kinirons et al., 2006;
Sinha & Satischandra, 2007; Bien & Elger, 2008; Yeh &
Wu, 2008; Mameniskiene et al., 2011). The most common
etiologies are cerebrovascular disorders (2428%), inflammatory causes (1519%), neoplasms (516%), and metabolic disorders (614%). Despite full neurologic work-up,
1928% of EPC cases have no identifiable cause (Thomas
et al., 1977; Cockerell et al., 1996; Sinha & Satischandra,
2007). Table 6 gives an overview of the causes of EPC.
Bancaud divided EPC into two types: type 1, caused by
focal static lesions of the sensorimotor cortex, and type 2,
caused by progressive cerebral lesions with neurologic
and intellectual deterioration (Bancaud, 1992). Type 2
most often reflects mitochondrial diseases and inflammatory causes, such as Rasmussen syndrome or Creutzfeldt
Jakob disease.
Viral infections
Prion disease
Other infections
Creutzfeldt-Jakob disease
Paracoccidioidomycosis
Paragonimiasis
Mucormycosis
135
Causes of Status Epilepticus
Table 9. Status epilepticus due to genetic diseases
Chromosomal aberrations
Inborn errors of
metabolism
Malformations of
cortical development
Neurocutaneous
syndromes
Sturge-Weber
syndrome
Tuberous sclerosis
Ring chromosome 20
Porphyria
Angelman syndrome
Menkes disease
Focal cortical
dysplasias
Hemimegalencephaly
Wolf-Hirschhorn syndrome
Wilsons disease
Polymicrogyria
Fragile X syndrome
X-linked mental retardation
syndrome
Ring chromosome 17
Alexanders disease
Gobalamin C/D
deficiency
Ornithine transcarbamylase
(OTC) deficiency
Hyperprolinemia
Maple-syrup urine disease
3-Methylcrotonyl CoA
carboxylase deficiency
Lysinuric protein intolerance
Hydroxyglutaric aciduria
Metachromatic
leukodystrophy
Kufs disease
Late infantile ceroid
lipofuscinosis
Beta-ureidopropionase
deficiency
Heterotopias
Schizencephaly
3-Hydroxyaxyl
CoA dehydrogenase
deficiency
Carnitine
palmitoyltransferase
Succinic semildehyde
dehydrogenase deficiency
Others
Retts syndrome
Dravet syndrome and
SCN1A gene mutation
spectrum
Migrating partial seizures
in infancy
Pyeridoxine dependency
Familial hemiplegic
migraine
Laforas disease
Dentato-rubro-pallido-luysian
atrophy
Infantile-onset
spinocerebellar ataxia
Wrinkly-skin syndrome
Neurocutaneous
melanomatosis
Neuroserpin mutation
Wolfram syndrome
Autosomal recessive
hyperekplexia
Cockayne syndrome
Cerebral autosomal
dominant arterio-pathy
with subcortical infarcts
and leuko
encephalopathy
(CADASIL)
Jeavons syndrome
Robinow syndrome
LYK5 mutation
MECP2 mutation
Malignant hyperpyrexia
Therapeutic Considerations
Given the wide variety of clinical presentations of SE,
ranging from life-threatening conditions to seemingly
harmless ones, it is important to tailor the treatment to the
type of status and to the underlying disorder. The clinical
presentation of SE determines the aggressiveness treatment. All treatment concepts on convulsive SE are based
on a staged approach (Fig. 4). In the early phase of convulsive SE, large randomized controlled trials support the use
of intravenous benzodiazepines. Alternatively, the intramuscular route is effective in the prehospital setting
(Silbergleit et al., 2012). In stage two, AEDs were used,
but it must be emphasized that there are no clinical trials
to inform the best drug treatment at this stage (Cock and
ESETT Group, 2011). Phenytoin, levetiracetam, and valproic acid are most often used (Shorvon et al,. 2008). The
newer AED lacosamide has also gained acceptance in the
community, but data on its effectiveness in convulsive
Epilepsia, 53(Suppl. 4):127138, 2012
doi: 10.1111/j.1528-1167.2012.03622.x
136
E. Trinka et al.
Table 10. Other causes of status epilepticus
Iatrogenic
Electroconvulsive therapy
Temporal lobectomy and
other neurosurgery
Insertion of intracranial electrode
Ventriculoperitoneal shunt
Blood transfusion
Carotid angioplasty and stenting
Multiple sclerosis
Hypertension-induced posterior
reversible encephalopathy
syndrome
Panayiotopoulos syndrome
Thyroid disease
Pyridoxine-dependent seizure
Neuroleptic malignant syndrome
Ulcerative colitis
Behcet syndrome
Celiac disease
Cobalamin deficiency
Folinic acid responsive seizures
Renal artery stenosis
Pituitary apoplexy
Renal artery dissection
Hypomelanosis of Ito
Cerebral palsy
Hemophagocytic
lymphohistiocytosis
Anhidrotic ectodermal dysplasia
Methemoglobinemia
Figure 6.
Treatment algorithm for superrefractory status
epilepticus. Modified after Shorvon & Ferlisi, 2011.
Epilepsia ILAE
Disclosure of Conflict
of Interest
Figure 5.
Staged approach to the treatment of convulsive status
epilepticus. *There is currently limited evidence for the
use of lacosamide in SE (see Hofler et al., 2011) Modified after Trinka, 2007; Shorvon et al., 2008.
Epilepsia ILAE
status are limited (Hfler et al., 2011; Trinka, 2011). From
stage three onward, intensive care unit treatment and general anesthesia are the mainstays of drug treatment. Again,
there are no randomized controlled trials informing the
effectiveness of individual drugs in this stage. Midazolam
seems to be better tolerated than pentobarbital/thiopental
and propofol (Shorvon & Ferlisi, 2012). A fourth stage of
status was recently introduced (Shorvon & Trinka, 2011),
and a treatment protocol was proposed by Shorvon and
Ferlisi (2011). Needless to say, all general measures for
intensive care treatment have to be applied at the beginEpilepsia, 53(Suppl. 4):127138, 2012
doi: 10.1111/j.1528-1167.2012.03622.x
References
Agathonikou A, Panayiotopoulos CP, Giannakodimos S, Koutroumanidis M. (1998) Typical absence status in adults: diagnostic and syndromic considerations. Epilepsia 39:12651276.
Aminoff MJ, Simon RP. (1980) Status epilepticus causes, clinical features and consequences in 98 patients. Am J Med 69:657666.
Andermann F, Robb JP. (1972) Absence status: a reappraisal following
review of thirty-eight patients. Epilepsia 13:177187.
Aydin-Ozdemir Z, Tzn E, Baykan B. (2006) Autoimmune thyroid
encephalopathy presenting with epilepsia partialis continua. Clin
EEG Neurosci 37:204209.
Bancaud J. (1992) Kojewnikovs syndrome (epilepsia partialis continua)
in children. In Roger J, Dravet C, Bureau M, Dreifuss FE, Wolf P
(Eds) Epileptic syndromes in infancy, childhood and adolescence.
2nd edn. John Libbey Eurotext, London, pp. 363379.
Bauer G, Trinka E. (2006) Seizures, syndromes and classifications.
Epileptic Disord 8:162163.
137
Causes of Status Epilepticus
Bauer G, Trinka E. (2010) Nonconvulsive status epilepticus and coma.
Epilepsia 51:177190.
Bauer G, Benke T, Unterberger I, Schmutzhard E, Trinka E. (2005) Transient global amnesia or transient epileptic amnesia? QJM 98:383;
author reply 383384.
Bauer G, Dobesberger J, Bauer R, Embacher N, Benke T, Unterberger I,
Walser G, Luef G, Trinka E. (2006) Prefrontal disturbances as the
sole manifestation of simple partial nonconvulsive status epilepticus.
Epilepsy Behav 8:22225.
Bauer G, Bauer R, Dobesberger J, Benke T, Walser G, Trinka E. (2007)
Absence status in the elderly as a late complication of idiopathic generalized epilepsies. Epileptic Disord 9:3942.
Berg AT, Berkovic SF, Brodie MJ, Buchhalter J, Cross JH, van Emde
Boas W, Engel J, French J, Glauser TA, Mathern GW, Mosh SL,
Nordli D, Plouin P, Scheffer IE. (2010) Revised terminology and
concepts for organization of seizures and epilepsies: report of the
ILAE Commission on Classification and Terminology, 20052009.
Epilepsia 51:676685.
Bien CG, Elger CE. (2008) Epilepsia partialis continua: semiology and
differential diagnoses. Epilept Disord 10:37.
Brenner RP. (2004) EEG in convulsive and nonconvulsive status epilepticus. J Clin Neurophysiol 21:319331.
Brenner RP. (2005) The interpretation of the EEG in stupor and coma.
Neurologist 11:271284.
Cock HR, ESETT Group. (2011) Established status epilepticus treatment
trial (ESETT). Epilepsia 52(Suppl. 8):5052.
Cockerell OC, Rothwell J, Thompson PD, Marsden CD, Shorvon SD.
(1996) Clinical and physiological features of epilepsia partial continua: cases ascertained in the UK. Brain 119:393407.
Coeytaux A, Reverdin A, Jallon P, Nahory A. (1999) Non-convulsive status epilepticus following intrathecal fluorescein injection. Acta Neurol Scand 100:278280.
Coeytaux A, Jallon P, Galobardes B, Morabia A. (2000) Incidence of
status epilepticus in French-speaking Switzerland: EPISTAR.
Neurology 55:693697.
Commission on Classification and Terminology of the International
League Against Epilepsy. (1981) Proposal for revised clinical
and electroencephalographic classification of epileptic seizures.
Epilepsia 22:489501.
Dalmau J, Gleichman AJ, Hughes EG. (2008) Anti-NMDA-receptor
encephalitis: case series and analysis of the effects of antibodies.
Lancet Neurol 7:10911098.
DeLorenzo RJ, Pellock JM, Towne AR, Boggs JG. (1995) Epidemiology
of status epilepticus. J Clin Neurophysiol 12:316325.
DeLorenzo RJ, Hauser WA, Towne AR. (1996) A prospective, population-based epidemiologic study of status epilepticus in Richmond,
Virginia. Neurology 46:10291035.
Drislane FW. (2000) Presentation, evaluation, and treatment of nonconvulsive status epilepticus. Epilepsy Behav 1:301314.
Engel J, Ludwig B, Fetell M. (1978) Prolonged partial complex status
epilepticus: EEG and behavioral observations. Neurology 28:863
869.
Fernandez-Torre JL. (2001) De novo absence status of late onset following withdrawal of lorazepam: a case report. Seizure 10:433437.
Gastaut H. (1970) Clinical and electroencephalographic classification of
epileptic seizures. Epilepsia 11:102113.
Genton P, Ferlazzo E, Thomas P. (2008) Absence status epilepsy: delineation of an adult idopathic generalized epilepsy syndrome. Epilepsia
49:642649.
Hauser WA. (1990) Status epilepticus: epidemiology considerations.
Neurology 40(Suppl. 2):912.
Hesdorffer DC, Logroscino G, Cascino G, Annegers JF, Hauser WA.
(1998) Incidence of status epilepticus in Rochester, Minnesota,
19651984. Neurology 50:735741.
Hilkens PHE, De Weerd AW. (1995) Non-convulsive status epilepticus
as cause for focal neurological deficit. Acta Neurol Scand 92:193
197.
Hfler J, Unterberger I, Dobesberger J, Kuchukhidze G, Walser G,
Trinka E. (2011) Intravenous lacosamide in status epilepticus and seizure clusters. Epilepsia 52:e148e152.
Holtkamp M, Othman J, Buchheim K, Meierkord H. (2005) Predictors
and prognosis of refractory status epilepticus treated in a neurological
intensive care unit. J Neurol Neurosurg Psychiatry 76:534539.
Huang CW, Hsieh YY, Pai MC, Tsai JJ, Huang CC. (2005) Nonketotic
hyperglycemia-related epilepsia partialis continua with ictal unilateral parietal hyperperfusion. Epilepsia 46:18431844.
Irani SR, Alexander S, Waters P, Kleopa KA, Pettingill P, Zuliani L,
Peles E, Buckley C, Lang B, Vincent A. (2010) Antibodies to Kv1
potassium channel-complex proteins leucine-rich, glioma inactivated
1 protein and contactin-associated protein-2 in limbic encephalitis,
Morvans syndrome and acquired neuromyotonia. Brain 133:2734
2748.
Irani SR, Michell AW, Lang B, Pettingill P, Waters P, Johnson MR,
Schott JM, Armstrong RJ, S Zagami A, Bleasel A, Somerville ER,
Smith SM, Vincent A. (2011a) Faciobrachial dystonic seizures
precede Lgi1 antibody limbic encephalitis. Ann Neurol 69:892900.
Irani SR, Schott JM, Vincent A, Smith SJ. (2011b) Tonic seizures: a diagnostic clue of anti-LGI1 encephalitis? Neurology 77:21402141;
author reply 2141-3.
Jacobs J, Bernard G, Andermann E, Dubeau F, Andermann F. (2008)
Refractory and lethal status epilepticus in a patient with ring chromosome 20 syndrome. Epileptic Disord 10:254259.
Jordan KG. (1999) Nonconvulsive status epilepticus in acute brain injury.
J Clin Neurophysiol 16:332340.
Kaplan PW. (1996) Nonconvulsive status epilepticus in the emergency
room. Epilepsia 37:643650.
Kinirons P, ODwyer JP, Connolly S, Hutchinson M. (2006) Paraneoplastic limbic encephalitis presenting as lingual epilepsia partialis continua. J Neurol 253:256257.
Knake S, Hamer HM, Schomburg U, Oertel WH, Rosenow F. (1999)
Tiagabine-induced absence status in idiopathic generalized epilepsy.
Seizure 8:314317.
Knake S, Rosenow F, Vescovi M, Oertel WH, Mueller HH, Wirbatz A,
Katsarou N, Hamer HM, Status Epilepticus Study Group Hessen
(SESGH). (2001) Incidence of status epilepticus in adults in Germany: a prospective, population-based study. Epilepsia 40:759762.
Larch J, Unterberger I, Bauer G, Reichsoellner J, Kuchukhidze G, Trinka
E. (2009) Myoclonic status epilepticus in juvenile myoclonic
epilepsy. Epileptic Disord 11:309314.
Lee K, Haight E, Olejniczak P. (2000) Epilepsia partialis continua in
Creuzfeldt-Jacob disease. Acta Neurol Scand 102:398402.
Logroscino G, Hesdorffer DC, Cascino G, Annegers JF, Hauser WA.
(1997) Short-term mortality after a first episode of status epilepticus.
Epilepsia 38:13441349.
Logroscino G, Hesdorffer DC, Cascino G, Hauser WA, Coeytaux A,
Galobardes B, Morabia A, Jallon P. (2005) Mortality after a first episode of status epilepticus in the United States and Europe. Epilepsia
46(Suppl. 11):4648.
Lowenstein DH, Aminoff MJ. (1992) Clinical, EEG features of status
epilepticus in comatose patients. Neurology 42:100104.
Lowenstein DH, Bleck T, Macdonald RL. (1999) Its time to reviseto
revise the definition of status epilepticus. Epilepsia 40:120122.
Malter MP, Helmstaedter C, Urbach H, Vincent A, Bien CG. (2010)
Antibodies to glutamic acid decarboxylase define a form of limbic
encephalitis. Ann Neurol 67:470478.
Mameniskiene R, Bast T, Bentes C, Canevini MP, Dimova P, Granata T,
Hgenhaven H, Jakubi BJ, Marusic P, Melikyan G, Michelucci R,
Mukhin KY, Oehl B, Ragona F, Rossetti AO, Rubboli G, Schubert S,
Stephani U, Strobel J, Vignoli A, Zarubova J, Wolf P. (2011) Clinical
course and variability of non-Rasmussen, nonstroke motor and sensory epilepsia partialis continua: a European survey and analysis of
65 cases. Epilepsia 52:11681176.
Obeso JA, Rothwell JC, Marsden CD. (1985) The spectrum of cortical
myclonus: from focal reflex jerks to spontaneous motor epilepsy.
Brain 108:193224.
Oguni H, Andermann F, Rasmussen T. (1991) The natural history of the
syndrome of chronic encephalitis and epilepsy: a study of the MNI
series of forty-eight cases. In Andermann F (Ed.) Chronic encephalitis and epilepsy: Rasmussens's syndrome. Butterworth-Heinermann,
Boston, MA, pp. 735.
Panayiotopoulos CP, Ferrie CD, Koutroumanidis M, Rowlinson S, Sanders S. (2001) Idiopathic generalized epilepsy with phantom absences
and absence status in a child. Epileptic Disord 3:6366.
Pandian JD, Thomas SV, Santoshkumar B. (2002) Epilepsia partialis
continua: a clinical and electroencephalography study. Seizure
11:437441.
Epilepsia, 53(Suppl. 4):127138, 2012
doi: 10.1111/j.1528-1167.2012.03622.x
138
E. Trinka et al.
Placidi F, Floris R, Bozzao A. (2001) Ketotic hyperglycemia and epilepsia partialis continua. Neurology 57:534537.
Pritchard PB III, ONeal DB. (1984) Nonconvulsive status epilepticus
following metrizamide myelography. Ann Neurol 16:252254.
Rossetti AO, Hurwitz S, Logroscino G, Bromfield EB. (2006) Prognosis of
status epilepticus: role of aetiology, age, and consciousness impairement at presentation. J Neurol Neurosurg Psychiatry 77:611615.
Scholtes FB, Renie WO, Meinardi HM. (1996) Non-convulsive status
epilepticus: causes, treatment, outcome in 65 patients. J Neurol
Neurosurg 61:9395.
Shorvon S. (1994) Status epilepticus: its clinical features and treatment
in children and adults. University Press, Cambridge.
Shorvon S, Ferlisi M. (2011) The treatment of super-refractory status
epilepticus: a critical review of available therapies and a clinical
treatment protocol. Brain 134(Pt 10):28022818.
Shorvon S, Ferlisi M. (2012) The outcome of therapies in refractory and
super-refractory convulsive status epilepticus and recommendations
for therapy. Brain May 9 [Epub ahead of print].
Shorvon S, Trinka E. (2011) Status epilepticus making progress.
Epilepsia 52(Suppl. 8):12.
Shorvon S, Walker M. (2005) Status epilepticus in idiopathic generalized
epilepsy. Epilepsia 46(Suppl. 9):7379.
Shorvon S, Baulac M, Cross H, Trinka E, Walker M. (2008) The drug
treatment of status epilepticus in Europe: censensus document from a
workshop at the first London Colloquium on Status Epilepticus.
Epilepsia 49:12771285.
Silbergleit R, Durkalski V, Lowenstein D, Conwit R, Pancioli A, Palesch
Y, Barsan W. (2012) Intramuscular versus intravenous therapy for
prehospital status epilepticus. N Engl J Med 366:591600.
Sinha S, Satischandra P. (2007) Epilepsia partialis continua over last
14 years: experience from a tertiary care center from south India.
Epilepsy Res 74:5559.
Snead OC, Hosey LC. (1985) Exacerbation of seizures in children by
carbamazepine. N Engl J Med 313:916921.
Tan R, Neligan A, Shorvon SD. (2010) Uncommon causes of status
epilepticus. Epilepsy Res 91:1122.
Theodore WH, Porter RJ, Albert P. (1994) The secondarily generalized
tonic-clonic seizure: a videotape analysis. Neurology 44:14011407.
Thomas P. (2011) Causes of non-convulsive status epilepticus in adults.
In Shorvon S, Andermann F, Guerrini R (Eds) The causes of epilepsy.
Cambridge University Press, Cambridge, pp. 752758.
Thomas P, Andermann F. (1994) Late-onset absence status epilepticus is
most often situation-related. In Malafosse A, Genton P, Hirsch E,
Marescaux C, Broglin D, Bernasconi R (Eds) Idiopahtic generalized
epilepsies. John Libbey, London, pp. 95109.
Thomas P, Gelisse P. (2009) Nonconvulsive status epilepticus. Rev
Neurol (Paris). 165:380389.
Thomas P, Snead OC III. (2007) Absence status epilepticus. In Engel J,
Pedley T (Eds) Epilepsy: a comprehensive textbook, 2nd ed. Lippincott William and Wilkins, Philadelphia, pp. 693703.
Thomas P, Zifkin B. (2008) Frontal lobe non convulsive status epilepticus. In Kaplan PWA, Dislane F (Eds) Non convulsive status epilepticus. Demos Biomedical, New York, pp. 91101.
Thomas JE, Reagan TJ, Klass DW. (1977) Epilepsia partialis continua:
a review of 32 cases. Arch Neurol 34:266275.
Thomas P, Beaumanoir A, Genton P, Dolisi C, Chatel M. (1992) De novo
absence status: report of 11 cases. Neurology 42:105110.
Thomas P, Valton L, Genton P. (2006a) Absence and myoclonic status
epilepticus precipitated by antiepileptic drugs in idiopathic generalized epilepsy. Brain 129:12811292.