REVIEW – January 2007

Status epileticus: An overview and analysis of the treatment protocol in the neurointensive care unit of Tartu University Hospital


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Generalized status epilepticus is characterized either by continuous seizures lasting at least five minutes, or by two or more discrete seizures between which there is incomplete recovery of consciousness. It is a critical clinical situation with an overall mortality rate of approximately 20% in adults. Acute processes that cause status epilepticus include metabolic disturbances (e.g. renal failure, sepsis), infections of the central nervous system, stroke, head trauma, drug toxicity and hypoxia.
Chronic processes causing status epileticus include preexisting epilepsy, seizures in the context of chronic alcohol abuse, remote processes after tumour removal, stroke and head trauma.
Status epilepticus lasting approximately 30 to 45 minutes can cause irreversible cerebral injury. Seizures should be terminated as soon as possible. Treatment should be started with benzodiazepines (diazepam, lorazepam, midozalam). If this treatment is not effective phenytoine should be added. In cases of refractory status epilepticus continuous intravenous infusion with anaestethic doses of midazolam, propofol or barbiturates are the most useful.
Proper assessment and control of the airway, ventilation, arterial blood pressure and metabolic acidosis should be carried out.
A retrospective analysis was performed of the treatment protocol of 122 patients with status epilepticus, admitted in 1997 – 2004 into the neurointensive care unit.
Results. 44 patients (36%) had the first seizures in lifetime, in 56 patients (46%) symptomatic epilepsia after previous brain damage (stroke, trauma, meningitis) was diagnosed, in 22 patients (18%) epilepsia had been diagnosed previously. In 73 patients (59%) status epilepticus was considered to be related to alcohol abuse.
In most cases prehospital treatment was started with benzodiazepines, 114 patients were intubated and artificial ventilation was introduced.
After seizures were terminated the patients were referred to other hospital departments. One patient with stroke died in the neurointensive care unit.
Conclusions. According to our material prehospital treatment of status epilepticus has been adequate. Alcohol abuse was considered the risk factor of status epilepticus in 59% of the patients.