Chapter 5 - Acute Seizures and Status Epilepticus

Abstract

Acute seizures are neurological emergencies with high morbidity and mortality. Most epileptic seizures are stopped within a few seconds to minutes by intrinsic seizure terminating mechanisms. Prolonged or repetitive seizures can lead to neuronal damage and clinical sequelae such as focal neurological deficits and cognitive impairment. Acute seizure emergencies fall into several subgroups based on the duration of seizures and the patient population affected. Status epilepticus (SE), continuous seizures lasting more than 30 minutes or serial seizures over 30 minutes without return to normal consciousness between seizures, has a mortality of up to 30% and high morbidity. Seizures may also occur in flurries or clusters with return to baseline consciousness between seizures. Such acute repetitive seizures (ARS) frequently require emergency room visits or hospitalization and may progress to SE. Prolonged seizures secondary to fever are particularly common in infants and young children. Although febrile SE has relatively low morbidity and mortality, it may increase the risk for subsequent epilepsy. Seizures and SE in neonates are often secondary to an underlying neurological disorder and may cause or exacerbate neuronal damage. Available treatments for seizure emergencies and SE are effective in terminating seizures in only about 60% of patients. This chapter reviews the epidemiology, pathophysiology, current management, and trial design methodology for acute prolonged or repetitive seizures and SE.