Most people with epilepsy have seizures that are brief and last the same length of time each time they happen and stop naturally. Occasionally though this does not happen and a seizure might go on for longer than normal. This is called Status Epilepticus. In practice treatment for Status normally starts from 5 minutes onwards but Status itself is defined as 30 minutes of continuous seizure activity, after which there is risk of damage. The administration of treatment at 5 minutes is recommended to prevent the seizure progressing to the defined point of 30 minutes.
The International League Against Epilepsy has proposed a new definition to deal with the two time related issues of 5 minutes and 30 minutes. This definition is conceptual and will put a framework on what is already common clinical practice. The proposed definition gives 2 time points in relation to status and it's treatment. The first time point (T1) is to say what is the earliest time to give treatment and the second (T2) to say when long term consequences are likely to happen. In the case of a tonic clonic status the first point is 5 minutes and the second is 30 minutes. These times are consistent with much current practice. Status can occur in other seizure types too and these would have different T1 and T2 points to tonic clonic seizures. These points for other seizure types have been traditionally less well defined in the literature so the definition could help establish a protocol which would have a value for treating clinicians in emergency department and beyond.
The task force also proposed a classification system for status epilepticus based on features such as symptoms, EEG findings, causes and age. This approach acknowledges there are other types of status besides convulsive status and supports the idea that these differences are reflected in any assessment.
While Status among epilepsy patients accounts for up to 40% of cases overall the rest is made up of non-epilepsy patients with brain injury, meningitis and strokes. According to Dr. Shlomo Shinnar, the author of the study by the task force this definition of Status will assist clinicians who are not epilepsy specialists with making appropriate treatment decisions and provide an agreed framework for doctors to communicate about Status and it's treatment in epilepsy and non-epilepsy cases.
Source : Wiley Online Library