Status epilepticus

Prolonged or recurrent seizures can cause life-threatening systemic and neurological complications. Status epilepticus (SE) has traditionally been defined as more than 30 min of either continuous seizure activity or a series of seizures during which there is incomplete recovery of consciousness. There are several reasons why a shorter duration might be more appropriate for an operational definition of SE. First, the duration of a generalized seizure rarely exceeds 2 min, and spontaneous resolution becomes unlikely after 5-10 min. Second, seizures become more difficult to abort pharmacologically over time. Third, systemic complications frequently occur even after a few minutes. Finally, the duration of time leading to neuronal injury is uncertain, and could conceivably be less than 30 min in certain cases. Longer seizure duration has been associated with worse outcomes. It would be inappropriate and harmful to delay pharmacologic treatment of seizures for 30 min. Consequently, recent large clinical trials assessing management of SE have employed durations of only 5-10 min in their inclusion criteria. Another approach that has been advocated to remain consistent with the previous definition is to define seizures lasting 10-29 min as impending SE.