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Assalamualaikum Wr. Wb.

Laura Rahardini

Advised by: dr. Donny H. Hamid, Sp.S

 Status
Epilepticus
 1.
Definition
Status Epilepticus
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SE is a condition resulting either from the

failure of the mechanisms responsible for
Definition seizure termination or from the initiation of
mechanisms which lead to abnormally
prolonged seizures (after time point t1). It is a
condition that can have long-term
consequences (after time point t2), including
neuronal death, neuronal injury, and alteration
of neuronal networks, depending on the type
and duration of seizures
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New Definition
The consensus of the International League Against
Epilepsy (ILAE)
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T1
NEW Definition •when treatment should be
initiated

T2
•the time point at which long-
term consequences may occur
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 2.
Epidemiology
Status Epilepticus
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Maps
Northern
Ireland

Virginia
incidence of 6
to 41 per
estimated 100,000 for
incidence was convulsive SE
41 per 100,000
population
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150 per 100,000 persons

children less than 1 year of age

>25 per 100,000 persons

Children 5 years of age

22.3 per 100,000 persons

in the elderly population
 3.
Pathophysiology
Status Epilepticus
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Before Physiological
30 compesation

Process

Increased metabolic
30
system

After
Decompesation
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 4.
Classification
Status Epilepticus
Semiology

Etiology

EEG

Age
Four Axes of Status Epilepticus
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The two main taxonomic criteria are:
1. The presence or absence of prominent
motor symptoms
Semiology 2. The degree (qualitative or quantitative) of
impaired consciousness

Convulsive SE Non-Convulsive SE
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Symptomatic
Etiology

Cryptogenic
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Etiology
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Location
Electroencepha-
lographic (EEG) • generalized (including bilateral
correlates synchronous patterns), lateralized,
bilateral independent, multifocal.
Name of the pattern
• Periodic discharges, rhythmic delta
activity or spike-and-wave/sharp-
and-wave plus subtypes.
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Morphology
Electroencepha-
lographic (EEG) • sharpness, number of phases (e.g.,
triphasic morphology), absolute and
correlates
relative amplitude, polarity.

Time-related features
• prevalence, frequency, duration, daily
pattern duration and index, onset
(sudden vs. gradual), and dynamics
(evolving, fluctuating, or static).
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Electroencepha- Modulation
lographic (EEG)
correlates
• stimulus-induced vs. spontaneous.

Effect of intervention
(medication) on EEG.
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○ Neonatal (0 to 30 days).
Infancy (1 month to 2 years).
Age ○
○ Childhood (> 2 to 12 years).
○ Adolescence and adulthood (> 12 to 59
years).
○ Elderly (≥ 60 years).
 5.
Diagnosis
Status Epilepticus
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Status Epilepticus Pseudostatus

Onset Sudden Gradual

Whole body
Tonic, then evolving into stiffening, with
Motor State clonic synchronous some voluntary
movements. movements at
times
Varying,
A definite tonic phase,
Evolution then clonic phase
tonic/clonic
movements
May occur in the
At onset, may have loud
middle of a seizure,
guttural cry as air is
Vocalisation forced out past a tonic
crying and
shouting are
larynx
possible
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Status Epilepticus Pseudostatus

Eye closure is not Eyes are commonly

Eyes typical forcibly closed

Typically superficial
Can have deep lateral
Tongue tongue biting
frontal tip of the
tongue location

Cyanosis Present Absent

Usually stereotyped Variable nature to

Consistency seizure episodes events

Variable
Responsive None withdrawal from
painful stimulus
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Status Epilepticus Pseudostatus

Prompt recovery.
Delayed recovery after
Recovery event, with amnesia
Non-organic
amnesia observed.

Nocturnal
Can happen Not recognised
seizures

Ictal Not a distinguishing Not a distinguishing

incontinence factor factor

Injuries Common Common

 6.
Treatment and
Management
Status Epilepticus
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○ An electroencephalogram (EEG) is not

immediately required for treatment, and
EEG the urgency of this test depends on the
patient’s clinical presentation and
response to treatment.
○ Other indications for emergent EEG in
patients prone to or being treated for SE
includes the use of neuromuscular
blockade and high-dose suppressive
therapy for the treatment of refractory SE
 “
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Don’t say you don’t have enough time. You

have exactly the same number of hours per
day that were given to Helen Keller,
Pasteur, Michelangelo, Mother Teresea,
Leonardo da Vinci, Thomas Jefferson, and
Albert Einstein. – H. Jackson Brown Jr.
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Thank You