Classification Of Status Epilepticus Research Articles

Management of Status Epilepticus, Refractory Status Epilepticus, and Super-refractory Status Epilepticus.

Status epilepticus is a serious condition caused by disorders and diseases that affect the central nervous system. In status epilepticus, hypersynchronous epileptic activity lasts longer than the usual duration of isolated self-limited seizures (time t1), which causes neuronal damage or alteration of neuronal networks at a certain time point (time t2), depending on the type of and duration of status epilepticus. The successful management of status epilepticus includes both the early termination of seizure activity and the earliest possible identification of a causative etiology, which may require independent acute treatment. In nonconvulsive status epilepticus, patients present only with subtle clinical signs or even without any visible clinical manifestations. In these cases, EEG allows for the assessment of cerebral function and identification of patterns in need of urgent treatment. In 2015, the International League Against Epilepsy proposed a new definition and classification of status epilepticus, encompassing four axes: symptomatology, etiology, EEG, and age. Various validation studies determined the practical usefulness of EEG criteria to identify nonconvulsive status epilepticus. The American Clinical Neurophysiology Society has incorporated these criteria into their most recent critical care EEG terminology in 2021. Etiology, age, symptomatology, and the metabolic demand associated with an increasing duration of status epilepticus are the most important determinants of prognosis. The consequences of status epilepticus can be visualized in vivo by MRI studies. The current knowledge about status epilepticus allows for a more reliable diagnosis, earlier treatment, and improved cerebral imaging of its consequences. Outcome prediction is a soft tool for estimating the need for intensive care resources.

Status of epileptic spasms: A study of 21 children

ObjectiveWe studied cases with long-lasting epileptic spasms (ES) considered as a spasm status analyzing type of epilepsy, epileptic syndrome, etiology, treatment, and outcome in 21 patients. MethodsWe evaluated the charts of 21 patients seen between June 2006 and July 2017 who met the electroclinical diagnostic criteria of a spasm status. The spasm status was defined as continuous ES lasting 30 min or longer. ResultsThe type of ES was mixed in nine patients, flexion in seven, and extension in five. Epileptic spasms were asymmetric in three patients and unilateral in two. They occurred on awakening in all patients, while during sleep they decreased in all and disappeared in three cases. The duration of the spasm status ranged from 40 min to 15 days according to the seizure diaries of patients and video-EEG recordings. Two well-defined subgroups of patients were recognized; the first included patients with West syndrome (WS) and the second other types of severe non-West epilepsy syndromes. The spasm status responded well to oral vigabatrin (VGB) in four patients, oral topiramate (TPM) in three, oral corticosteroids in one, and cannabidiol in another patient. A good response was observed with benzodiazepines in six patients, with phenytoin (PH) in two, and with phenobarbital (PB) in one. Adrenocorticotropic hormone (ACTH) was effective in one patient and the ketogenic diet in two. Prognosis depends on the etiology. ConclusionIn this study we identified patients with WS and other types of severe non-West epilepsy syndromes who had a particular type of long-lasting ES that, in spite of its long duration does not strictly meet the criteria of the International League against Epilepsy (ILAE) classification of status epilepticus, may be considered a spasm status.

Epidemiology of status epilepticus in a non-urban area in Switzerland.

The aim of this study is to provide a precise population-based data on incidence, types, and causes of SE according to the 2015 ILAE definition and classification using a prospectively cohort in an adult population of a non-urban area. Prospective observational SE cohort in a single large community hospital. The center is the only one in the region (French-speaking Valais canton), with all available resources to treat SE (including neurologist available 24/7, EEG monitoring and ICU). Every adult patient with SE is included (except post-anoxic SE). All variables are collected prospectively using the 2015 ILAE status epilepticus classification. We identified 103 patients with SE in the study period between 1st of May 2015 and 30th of June 2019 for a population of 260,855 people. The incidence is 8.6 per 100,000 adults per year with an overall case-fatality rate of 7.8%. SE was generalized convulsive in 52% of cases and nonconvulsive SE in coma in 34%. Using a prospective reliable data collection with strict inclusion criteria, we found an incidence of 8.6 per 100,000 persons per year, in line with previous report using similar methods. The most severe forms-generalized convulsive and nonconvulsive SE in coma-represent the majority of cases. These data might be important for resources allocation in non-urban area with non-university healthcare system.

Status Epilepticus Manifested as Continuous Epileptic Spasms.

Objective: The etiology and outcome of status epilepticus with continuous epileptic spasms have not been fully understood; and only rare cases have been reported in the literature. Here, we described 11 children, who manifested continuous epileptic spasms with various etiologies and different outcomes.Methods: This is a case series study designed to systematically review the charts, video-electroencephalography (video-EEG), magnetic resonance images, and longitudinal follow-up of patients who presented continuous epileptic spasms lasting more than 30 min.Results: Median age at onset was 2 years old, ranging from 2 months to 5.6 years. The etiology of continuous epileptic spasms for these 11 cases consisted of not only some known electro-clinical epilepsy syndromes like West Syndrome and Ohtahara Syndrome, but also secondary symptomatic continuous epileptic spasms, caused by acute encephalitis or encephalopathy, which extends the etiological spectrum of continuous epileptic spasms. The most characteristic feature of these 11 cases was prolonged epileptic spasms, lasting for a median of 13.00 days (95% CI: 7.26–128.22 days). The interictal EEG findings typically manifested as hypsarrhythmia or its variants, including burst suppression. Hospital stays were much longer in acute symptomatic cases than in primary epileptic syndromic cases (59.67 ± 50.82 vs. 15.00 ± 1.41 days). However, the long-term outcomes were extremely poor in the patients with defined electro-clinical epilepsy syndromes, including severe motor and intellectual developmental deficits (follow-up of 4.94 ± 1.56 years), despite early diagnosis and treatment. Continuous epileptic spasms were refractory to corticosteroids, immuno-modulation or immunosuppressive therapies, and ketogenic diet.Conclusion: Continuous epileptic spasms were associated with severe brain impairments in patients with electro-clinical syndromes; and required long hospital stays in patients with acute symptomatic causes. We suggest to include continuous epileptic spasms in the international classification of status epilepticus, as a special form. Further investigations are required to better recognize this condition, better understand the etiology, as well as to explore more effective treatments to improve outcomes.

Status epilepticus: Management and prognosis

Status epilepticus is one of the most common neurological emergencies. Its incidence in adults is 36.1/100.000 per year (Leitinger et al. Epilepsia 2019). Less than half of the patients had previous seizures. Mortality varies according to the type of SE: case fatality is lower in awake patients (8.2%) compared with patients with impaired consciousness (33%) (Leitinger et al. Epilepsia 2019). SE is defined as “a condition resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms, which lead to abnormally, prolonged seizures (after time point t1). It is a condition, which 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”. (Trinka et al. Epilepsia 2015). It is a highly dynamic condition, which requires early diagnosis and treatment to prevent long term consequences. About 60% of patients in Convulsive SE (CSE) will be controlled by first line treatment (Trinka et al. Expert Opin Pharmacother. 2016). Recent studies suggest, that there is significant undertreatment in the early stages of status: Up to 80% receive not the recommended dose of Benzodiazepines (Kellinghaus et al. Ann Neurol 2019). If treatment is delayed, or the patient does not respond to adequate Benzodiazepines the stage of refractory SE (RSE) is reached, where anaesthetic treatments are necessary. The causes of SE must be identified by all means [8]. Common causes should be established in the first hours and treated appropriately, if causes cannot be identified the term NORSE (New Onset RSE) is used. At this stage extensive investigations are necessary to identify (and treat) the cause. In nearly 50% of cases, the probable cause of NORSE can eventually be determined. (Gaspard et al. Neurology 2015). The most commonly identified etiologies include autoimmune (19%) and paraneoplastic encephalitis (18%) or infection-related (8%). Once the patient is under general anaesthesia, major complications, such as pneumonia, immunosuppression, acidosis, metabolic derangements, cardiac suppression, gastric paresis, and others have to be managed appropriately. Overall RSE and super-refractory SE (SRSE), which does not respond to > 24h of general anaesthesia, is rare (7.2 and 1.2 / 100.000 / year), but mortality is highest in this group (Leitinger et al. Epilepsia 2019). One of the main diagnostic challenges at this stage, which is still unsolved, is the distinction between coma due to SE and coma with SE like EEG patterns (Trinka and Bauer Epilepsia 2009). This presentation will give an up to date overview on management and prognosis of SE.[1Bauer G. Trinka E. Nonconvulsive status epilepticus and coma.Epilepsia. 2010; 51: 177-190Google Scholar, 2Gaspard N. Foreman B.P. Alvarez V. Cabrera Kang C. Probasco J.C. Jongeling A.C. Meyers E. Espinera A. Haas K.F. Schmitt S.E. Gerard E.E. Gofton T. Kaplan P.W. Lee J.W. Legros B. Szaflarski J.P. Westover B.M. LaRoche S.M. Hirsch L.J. Critical Care EEG Monitoring Research Consortium (CCEMRC). New-onset refractory status epilepticus: Etiology, clinical features, and outcome.Neurology. 2015; 85: 1604-1613Google Scholar, 3Hirsch L.J. Gaspard N. van Baalen A. Nabbout R. Demeret S. Loddenkemper T. Navarro V. Specchio N. Lagae L. Rossetti A.O. Hocker S. Gofton T.E. Abend N.S. Gilmore E.J. Hahn C. Khosravani H. Rosenow F. Trinka E. Proposed consensus definitions for new-onset refractory status epilepticus (NORSE), febrile infection-related epilepsy syndrome (FIRES), and related conditions.Epilepsia. 2018; 59: 739-744Google Scholar, 4Kellinghaus C. Rossetti A.O. Trinka E. Lang N. May T.W. Unterberger I. Rüegg S. Sutter R. Strzelczyk A. Tilz C. Uzelac Z. Rosenow F. Factors predicting cessation of status epilepticus in clinical practice: Data from a prospective observational registry (SENSE).Ann Neurol. 2019; 85: 421-432Google Scholar, 5Leitinger M. Trinka E. Giovannini G. Zimmermann G. Florea C. Rohracher A. Kalss G. Neuray C. Kreidenhuber R. Höfler J. Kuchukhidze G. Granbichler C. Dobesberger J. Novak H.F. Pilz G. Meletti S. Siebert U. Epidemiology of status epilepticus in adults: A population-based study on incidence, causes, and outcomes.Epilepsia. 2019; 60: 53-62Google Scholar, 6Trinka E. Cock H. Hesdorffer D. Rossetti A.O. Scheffer I.E. Shinnar S. Shorvon S. Lowenstein D.H. A definition and classification of status epilepticus--Report of the ILAE Task Force on Classification of Status Epilepticus.Epilepsia. 2015; 56: 1515-1523Google Scholar, 7Trinka E. Höfler J. Leitinger M. Rohracher A. Kalss G. Brigo F. Pharmacologic treatment of status epilepticus.Expert Opin Pharmacother. 2016; 17: 513-534Google Scholar, 8Trinka E. Höfler J. Zerbs A. Causes of status epilepticus.Epilepsia. 2012; 53: 127-138Google Scholar]

The Clinical Spectrum of New-Onset Status Epilepticus.

There is a paucity of data on patients with new-onset status epilepticus in patients without a prior history of epilepsy; we aimed to describe clinical characteristics and assess variables predictive of outcomes. Retrospective cohort. Quaternary academic medical center. Adult patients with new-onset status epilepticus. Retrospective review of adults with new-onset status epilepticus admitted to Mayo Clinic, Rochester MN between January 1, 1990, and December 31, 2015, was performed. Patient demographics, status epilepticus etiology, Status Epilepticus Severity Score, and status epilepticus classification per the Status Epilepticus Severity Score were recorded. Six-month mortality and functional outcomes defined as modified Rankin scale (≥3 at last follow-up was considered poor) were primary outcomes. Refractory status epilepticus was a secondary outcome. None. One-hundred seventy-seven patients were included. Status epilepticus was convulsive in 124 (70.1%) and nonconvulsive in 53 (29.9%); 96 cases (54.2%) were refractory status epilepticus. Mean age at onset was 63 ± 18 years; 52.5% were greater than or equal to 65 years. Etiologies were acute in 50.8%, progressive in 18.1%, remote in 19.2%, and unknown in 11.9% patients. Six-month mortality was 32.2%, and 70.1% had poor modified Rankin scale at mean follow-up 3.1 ± 3.5 years. Age greater than or equal to 65 was a significant predictor of poor functional outcome and 6-month mortality. Loss of consciousness, status epilepticus classification, or age greater than or equal to 65 did not predict progression to refractory status epilepticus. Progression to refractory status epilepticus did not impact functional outcome or mortality at last follow-up. Poor outcomes in new-onset status epilepticus were associated with older age as well as predominantly progressive or remote symptomatic disease. Further prospective investigations assessing the course and outcomes of these patients would be useful in management and prognostication.

EpiNet study of incidence of status epilepticus in Auckland, New Zealand: Methods and preliminary results.

The EpiNet project has been commenced to facilitate investigator-led collaborative research in epilepsy. A new Web-based data collection tool has been developed within EpiNet to record comprehensive data regarding status epilepticus and has been used for a study of status epilepticus in Auckland, New Zealand. All patients aged >4weeks who presented to any of the five public hospitals and the major private hospital within Auckland city (population = 1.61 million) with an episode of status epilepticus between April 6, 2015 and April 5, 2016 were identified using multiple overlapping sources of information. For this study, status epilepticus was defined as any seizure exceeding 10minutes in duration, or repeated seizures lasting >10minutes without recovery between seizures. Patients who had either convulsive or nonconvulsive status epilepticus were included. Episodes of status epilepticus were classified according to the 2015 International League Against Epilepsy ILAE status epilepticus classification. A total of 477 episodes in 367 patients were considered as definite or probable status epilepticus; 285 episodes (62%) lasted >30minutes, which is the duration that has previously been used for epidemiological studies of status epilepticus.

P87. Does semiology of status epilepticus have an impact on refractoriness and outcome?

Objective This study investigated the significance of semiology of status epilepticus (SE) with respect to etiology, response to treatment and outcome in a large cohort of a single center. Method Two hundred ninety-eight adult patients (138 male, 160 female) who were diagnosed and treated consecutively for SE at the University of Munich Neurology Department over a period of 6 years were prospectively enrolled. Mean age was 63.2 ± 17.5 (18–97). Clinical and demographic of the patients, seizure semiology and EEG findings, neuroimaging and laboratory data, etiology and duration of SE, level of consciousness at admission, treatment and outcome measures were investigated. All SE events were classified semiologically into subcategories according to the Semiological Classification of Status Epilepticus (SCSE). STESS (Status Epilepticus Severity Score) was also evaluated as a prognostic factor for outcome. Patient’s mental and physical functional state at discharge were measured through Glaskow Outcome Scale (GOS). Results The most frequent seizure type was nonconvulsive status epilepticus (NCSE) (39.6%), followed by SE with prominent motor symptoms (32%). The most frequent etiologies were cerebrovascular disease (46.6%) and brain tumors (15.6%). A potentially fatal etiology was detected in 34.8% of the patients. Nearly 61% of all patients had poor short-term outcome (GOS ⩽ 8) at admission, high STESS, de novo seizures, systemic infections during SE, comatose state, refractory SE and long duration SE (>24 h) were associated with poor short term outcome and death (p Conclusion SE semiology has no association with outcome but potentially fatal etiology and low GCS were strong factors associated with poor short term outcome of SE.

The electroclinical spectrum, etiologies, treatment and outcome of nonconvulsive status epilepticus in the elderly

BackgroundNonconvulsive status epilepticus (NCSE) in the elderly is particularly difficult to diagnose, mainly due to subtle clinical manifestations and associated comorbidities. The recently validated electroencephalography (EEG) diagnostic criteria for NCSE and the proposed operational classification of status epilepticus provide tools that can allow an earlier diagnosis and better management of NCSE in this age group, possibly contributing to reduce its high mortality. Material and methodswe used these tools to identify and characterize a cohort of elderly (>60year-old) patients admitted at our institution in a 3-year period; the video-EEG and clinical files of the patients fulfilling EEG diagnostic criteria for NCSE were reviewed, being in this study described their electroclinical spectrum, etiologies, treatment, inhospital mortality, and status epilepticus severity score (STESS). ResultsFourty patients (23 women; mean age 76.6years) were identified. Although dyscognitive NCSE associated with >2.5Hz of epileptiform discharges (ED) was the most frequent electroclinical phenotype, this was quite heterogeneous, ranging from patients with aura continua to patients in coma, associated with frequent ED or rhythmic slow activities. Acute symptomatic (45%) and multifactorial (27.5%) etiologies were the most common, and associated with the worst prognosis. There was a trend to use newer antiepileptic drugs in the early steps of NCSE treatment. The inhospital mortality was high (22.5%) and predicted by STESS scores ≥3. ConclusionIn the elderly, NCSE has heterogeneous electroclinical phenotypes and etiologies. In spite of the treatment limitations conditioned by the comorbidities, more aggressive treatments could be justified to reduce mortality in patients with high STESS scores.

Recent advances in status epilepticus.

This review discusses advances in the understanding of the mechanisms of status epilepticus and its current treatment approaches. Many of these have been topics at the 5th London-Innsbruck Colloquium on status epilepticus 2015. A new definition and classification of status epilepticus was proposed, which is expected to improve treatment and stimulate research. A better understanding of the failure of seizure suppressing mechanisms and the initiation of self-sustaining seizures begins to translate into the clinical arena. Drugs, such as allopregnanolone, cannabinoids, sec-butylpropylacetamide and valnoctamide, may better target these seizure-perpetuating mechanisms. The concept of combinatorial treatments has further developed, but yet trials in humans are lacking. A new prognostic outcome-score and electroencephalography-criteria for nonconvulsive status epilepticus are ready for clinical use. Alternative routes, such as intranasal or buccal, have been explored in a number of trials suggesting that intramuscular midazolam is at least as effective as intravenous lorazepam and buccal or intranasal midazolam is at least as effective as rectal diazepam. Despite progress in basic science, translation into the clinical field remains difficult. There is hope, that the two large phase III studies in the established and refractory status that started recruitment in 2015 will better inform the clinicians in this emergency situation.

Determination and classification of Status Epilepticus (comments to the ILAE report)

Determination and classification of Status Epilepticus (comments to the ILAE report)

A definition and classification of status epilepticus--Report of the ILAE Task Force on Classification of Status Epilepticus.

The Commission on Classification and Terminology and the Commission on Epidemiology of the International League Against Epilepsy (ILAE) have charged a Task Force to revise concepts, definition, and classification of status epilepticus (SE). The proposed new definition of SE is as follows: Status epilepticus is a condition resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms, which lead to abnormally, prolonged seizures (after time point t1 ). It is a condition, which 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. This definition is conceptual, with two operational dimensions: the first is the length of the seizure and the time point (t1 ) beyond which the seizure should be regarded as "continuous seizure activity." The second time point (t2 ) is the time of ongoing seizure activity after which there is a risk of long-term consequences. In the case of convulsive (tonic-clonic) SE, both time points (t1 at 5min and t2 at 30min) are based on animal experiments and clinical research. This evidence is incomplete, and there is furthermore considerable variation, so these time points should be considered as the best estimates currently available. Data are not yet available for other forms of SE, but as knowledge and understanding increase, time points can be defined for specific forms of SE based on scientific evidence and incorporated into the definition, without changing the underlying concepts. A new diagnostic classification system of SE is proposed, which will provide a framework for clinical diagnosis, investigation, and therapeutic approaches for each patient. There are four axes: (1) semiology; (2) etiology; (3) electroencephalography (EEG) correlates; and (4) age. Axis 1 (semiology) lists different forms of SE divided into those with prominent motor systems, those without prominent motor systems, and currently indeterminate conditions (such as acute confusional states with epileptiform EEG patterns). Axis 2 (etiology) is divided into subcategories of known and unknown causes. Axis 3 (EEG correlates) adopts the latest recommendations by consensus panels to use the following descriptors for the EEG: name of pattern, morphology, location, time-related features, modulation, and effect of intervention. Finally, axis 4 divides age groups into neonatal, infancy, childhood, adolescent and adulthood, and elderly.

Non-convulsive status epilepticus in adults - an overview

Status epilepticus (SE) is the most frequent neurological emergency requiring admission on the intensive care unit (ICU). The classification of status epilepticus may be dichotomised into the and the form. Whereas the diagnosis of generalised convulsive status epilepticus (GCSE) is easily made in view of the evident manifestation, the diagnosis of non-convulsive status epilepticus (NCSE) may become very difficult according to its non-spectacular and protean presentation. Non-convulsive status epilepticus is a common cause of altered mental status and delirium; and a substantial number of comatose patients in the intensive care unit may suffer from NCSE. The most important part of making a diagnosis of NCSE is to think of it at all. The definite diagnosis of NCSE is dependent on electroencephalographic (EEG) confirmation. Repetitive or, optimally, continuous EEG recording may help to closely monitor seizure activity and to guide the therapy in order to protect the patient from under- and/or over-treatment. The interpretation of EEG recordings of NCSE may become challenging because of numerous artifacts caused by the patient, caregivers and devices, and because of trace elements of ambiguous significance and of waveforms mimicking epileptic activity. Non-convulsive status epilepticus was historically subdivided into the groups of complex-partial status epilepticus (focal; CPSE) and absence status (generalised; AS). Most recently, a classification proposed by the International League Against Epilepsy (ILAE) has subdivided focal NCSE into aura continua (non-convulsive simple partial with maintained consciousness) and into dys-cognitive (with impaired consciousness) of mesial temporal or neocortical origin. Several patients with focal NCSE or AS were known for pre-existing epilepsy. In addition, other types of NCSE have been reported, like subtle where convulsions in patients with GCSE clinically stop, but the continuous epileptic activity electroencephalographically still persists. Another variant belongs to those patients with critical illness where the serious disorder and/or medications may trigger an acute, prolonged and all too often very-hard-to-treat epileptic condition (critical illness SE [CISE]). The majority of these patients will never have had seizures before. Of note, none of the currently proposed classifications has gained broad acceptance and official approval. Since the need for immediate and intensive treatment of GCSE is beyond debate, the insidiously calm presentation of NCSE may mislead to a much less aggressive therapeutic approach. However, experimental and clinical data suggest that continuous epileptic activity in the brain during NCSE associated with consecutive (glutamatergic) hyperexcitation triggers neurotoxicity and proapoptotic mechanisms which eventually may lead to irreversible brain damage and the onset of a chronic epileptic disorder or to an irreversible neurological deficit. Thus, recent national and international guidelines and reviews recommend immediate and intensive treatment for NCSE as well as for GCSE. With a few exceptions, the first drug is an intravenous benzodiazepine, mainly lorazepam; intravenous phenytoin or valproate should be started without delay. Persistence of NCSE after administration of these two classes of drugs heralds refractory (RSE) where single or combinations of drugs in anaesthetic dosages requiring intubation and enteral antiepileptics may be added except for the cases of AS or an underlying terminal disease. The outcome of NCSE is mainly determined by the type, duration, cause and the severity of concomitant diseases.

What is nonconvulsive status epilepticus, and what are its subtypes?

Prolonged nonconvulsive seizures have been recognized at least since the 19th century, although their inclusion within the rubric of status epilepticus was only formalized by Gastaut and colleagues after the Xth Marseilles Colloquium, held in 1962 (Gastaut et al., 1967). This was the first ever large meeting devoted to the topic of status epilepticus, and the concept that there were status forms for every seizure type was formulated there. The classification of status epilepticus derived from the 1962 colloquium thus mirrored exactly the newly evolved International Classification of Seizure Type (Gastaut, 1970). The main disadvantage of a classification based on seizure type is that it does not take into account the broader range of phenomenology of epilepsy, which is especially significant in regard to nonconvulsive seizures. A seizure type classification does not do justice to the variety of forms and to their widely varying pathophysiological basis, prognosis, or clinical setting.

A semiological classification of status epilepticus

To the Editor: We read with great interest the thoughtful review of Prof Simon Shorvon of our paper titled «A semiological classification of status epilepticus» ( Epileptic Disord 2005; 7: 1‐3). Prof Shorvon is one of the world experts in status epilepticus, and this is certainly reflected in this insightful review.

A semiological classification of status epilepticus

The classification of status epilepticus (SE) has been a subject of discussion for many years, yet no satisfactory agreement has been reached. Due to their complexity, status episodes often defy classification according to the current international classification scheme. The semiological seizure classification (SSC) has been in use in several epilepsy centers for more than a decade, and has proven to be a valid approach to the classification of epileptic seizures. Based on the detailed analysis of more than 100 episodes of SE documented with video‐EEG recordings, the authors now present a proposal for a semiological classification of status epilepticus (SCSE). The SCSE reflects the assumption implied by all modern definitions of SE that “there are as many types of status as there are types of seizures” and relies on the same principles as the SSC, focusing on the main clinical manifestations and the evolution of the status episode. The clinical manifestations of SE are subdivided into semiological components and classified along three axes: the type of brain function predominantly compromised by the seizure activity, the body part involved, and the evolution over time. Each axis contains several subcategories, so that many different levels of accuracy are possible. The SCSE, just like the SSC, is meant to be part of a comprehensive epilepsy classification which classifies as independent variables (epileptogenic zone, ictal semiology, etiology, related medical conditions) the main features of the patient's epilepsy, allowing for each variable maximum flexibility. [Published with videosequences]

Evaluation of an algorithm for treatment of status epilepticus in adult patients undergoing video/EEG monitoring.

Convulsive or generalized tonic clonic status epilepticus (SE) is a neurological emergency that can lead to transient or permanent brain damage or even death. An algorithm was designed to aid nursing and medical staff members in decision making about the type of SE and pharmacological intervention needed to stop prolonged or repetitive seizures. Fifteen registered nurses at a northern New England medical center's epilepsy unit participated in educational sessions on classification of seizures and status epilepticus prior to use of the algorithm. A pretest-posttest design with an investigator-developed tool was used to measure SE knowledge before and after educational intervention. There was a significant improvement in scores on the posttest of the classification of status epilepticus (Z = -2.93, p = .003). Twenty-nine medical records of patients who had experienced SE between February 1992 and December 1997 were reviewed. Nineteen patients experienced SE before the algorithm was implemented, and 10 patients experienced SE after the algorithm was implemented. A total of 16 patients experienced generalized convulsive SE with 12 episodes occurring before and 4 episodes after algorithm implementation. The mean time taken to stop the episode of SE after pharmacologic treatment began was compared in both groups using a t-test. The mean difference between the groups was 235 minutes (t = 2.57, p = .026). The findings of this project demonstrate that combining a treatment algorithm with education of staff members on its use has benefits in the practice setting of an inpatient comprehensive epilepsy program. Episodes of SE are more accurately classified and successful treatment of the episodes occurs earlier.

Status Epilepticus in Children: Update and Review

This report presents a brief description and classification of status epilepticus. This neurologic emergency occurs more frequently in young children and elderly adults, although patients of all ages may experience prolonged seizures. The pathophysiology and prognosis of the disorder are presented, as well as a review of drugs commonly used for the treatment of convulsive status epilepticus. The morbidity and mortality of status epilepticus are significant and directly dependent upon prompt and appropriate medical therapy. Advances in understanding various aspects of status epilepticus may lead to improved outcome for affected patients.