Status epilepticus

Introduction
Status epilepticus is occur when a continuous seizure activity lasting more than five minutes or when seizures occur close together and the person doesn't recover between seizures. There are also different types of status epilepticus.
Convulsive Status Epilepticus
This term is used to describe the more common form of emergency situation that can occur with prolonged or repeated tonic-clonic (also called convulsive or grand mal) seizures. Most tonic-clonic seizures end normally in 1 to 2 minutes, but they may have post-ictal (or after-effects) symptoms for much longer. Convulsions may involve jerking motions, grunting sounds, drooling, and rapid eye movements. This makes it hard to tell when a seizure begins and ends.

Nonconvulsive Status Epilepticus

This term is used to describe long or repeated absence or complex partial seizures.

People with this type may appear confused or look like they're daydreaming. They may be unable to speak and may be behaving in an irrational way. (Epilepsycom, 2015)

Presentation 
Signs & symptoms

·         Muscle spasms

·         Falling because of uncontrollable jerking movements of the arms and legs

·          Loss of consciousness or awareness

·         Unusual noises

·         Loss of bowel or bladder control

·         Clenched teeth

·         Irregular breathing

·         Unusual behavior

·         Difficulty speaking

·         A "daydreaming" look  or   Temporary confusion (Mayoclinicorg, 2015)

Causes

·         Genetic influence

·         Head trauma

·         Brain conditions, such as brain tumors or strokes, can cause epilepsy. Stroke is a leading cause of epilepsy in adults older than age 35.

·         Infectious diseases such as meningitis, AIDS and viral encephalitis

·         Prenatal injury such as an infection in the mother, poor nutrition or oxygen deficiencies. This brain damage can result in epilepsy or cerebral palsy.

·         Developmental disorders such as autism and neurofibromatosis.

Risk factors

·         Age. The onset of epilepsy is most common during early childhood and after age 60

·         Family history

·         Head injuries

·         Stroke and other vascular diseases

·         Dementia

·          Brain infections

·         Seizures in childhood

Diagnose

·    Electroencephalogram (EEG).

·         Computerized tomography (CT) scans. CT scans can reveal abnormalities in the brain that might be causing seizures, such as tumors, bleeding and cysts.

·         Magnetic resonance imaging (MRI). Able to detect lesions or abnormalities in the brain that could be causing seizures.

·         Functional MRI (fMRI). A functional MRI measures the changes in blood flow that occur when specific parts of the brain are working.

·         Positron emission tomography (PET). PET scans use a small amount of low-dose radioactive material that's injected into a vein to help visualize active areas of the brain and detect abnormalities.

·         Single-photon emission computerized tomography (SPECT) A SPECT test uses a small amount of low-dose radioactive material that's injected into a vein to create a detailed, 3-D map of the blood flow activity in the brain during seizures.

·         Neuropsychological tests. In these tests, doctors assess the thinking, memory and speech skills. The test results helps to determine which areas of brain are affected. (Hopkinsmedicineorg, 2015)

Management 

drug therapy

Anti-epileptic drugs (AED)

Generally, they work by changing the levels of the chemicals in your brain that conduct electrical impulses. This reduces the chance of a seizure.

Examples of commonly used AEDs include,

Sodium valproate

Carbamazepine

Lamotrigine

Levetiracetam

Oxcarbazepine

Ethosuximide

Topiramate

also using, Diazepam,  Lorazepam,  Phenytoin,  Fosphenytoin, Phenobarbital

Side effects

Side effects are common when starting treatment with AEDs. drowsiness

• a lack of energy
• agitation
• headaches 
• uncontrollable shaking or tremor
• hair loss or unwanted hair growth
• swollen gums
• rashes

Surgery

Epilepsy surgery to removes the area of the brain that's causing the seizures.

Therapies

       Vagus nerve stimulation. In vagus nerve stimulation, implant a device called a vagus nerve stimulator underneath the skin of chest, similar to a heart pacemaker. Wires from the stimulator are connected to the vagus nerve in the neck.

      Ketogenic diet. Some children with epilepsy have been able to reduce their seizures by following a strict diet that's high in fats and low in carbohydrates. In this diet, called a ketogenic diet, the body breaks down fats instead of carbohydrates for energy. After a few years, some children may be able to stop the ketogenic diet and remain seizure-free.

Potential future treatments is deep brain stimulation (Uptodatecom, 2015)

References

Hopkinsmedicineorg. 2015. Hopkinsmedicineorg. [Online]. [20 April 2015]. Available from: http://www.hopkinsmedicine.org/healthlibrary/conditions/nervous_system_disorders/status_epilepticus_134,42/

Mayoclinicorg. 2015. Mayoclinicorg. [Online]. [20 April 2015]. Available from: http://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/dxc-20117207

Uptodatecom. 2015. Uptodatecom. [Online]. [20 April 2015]. Available from: http://www.uptodate.com/contents/convulsive-status-epilepticus-in-adults-classification-clinical-features-and-diagnosis

Epilepsycom. 2015. Epilepsy Foundation. [Online]. [21 April 2015]. Available from: http://www.epilepsy.com/learn/impact/seizure-emergencies/status-epilepticus