What is Status Epilepticus?

Status Epilepsticus occurs either because of a failure of mechanisms which stop seizure activity or because mechanisms within the body, which lead to prolonged seizures, are activated. Given the risk of prolonged seizures and the need to provide effective first aid, SE is defined as seizures lasting longer than 5 minutes or repeated seizures without full recovery to normal conscious levels between seizures. 

Research studies into Status Epilepticus have previously defined SE as seizures lasting longer than 30 minutes or clusters of seizures without recovery to normal consciousness between seizures lasting for 20 minutes or longer (ILAE taskforce.) 

Both focal and generalised seizures (convulsive and non-convulsive) may progress to Status Epilepticus. The most serious type is convulsive or generalised tonic-clonic status epilepticus. All SE is a medical emergency and requires immediate treatment. While Status Epilepticus is rare, it is more common in children and those over 60 years of age.

Non-convulsive Status Epilepticus is much harder to recognise. A person may exhibit a change in level of consciousness, behaviour and cognitive processes. The person may appear confused or disoriented, the eyes may be partially closed and the person appears to be in a trance-like state. If untreated these episodes may last for days or weeks. 

Prolonged seizures or clusters of seizures require fast and effective action. Intranasal or buccal Midazolam is used in the acute treatment of various kinds of seizures. Every person who has Midazolam prescribed should have an emergency management plan which should be reviewed each year. Carers need to be trained in how and when to use the medication and to follow individual plans. In order to protect the person having the seizures and those administering the medication, it is important to follow all relevant guidelines for the administration of Midazolam. 

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