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Status epilepticus given new definition

A serious type of seizure known as status epilepticus has been given a proposed new definition and treatment protocol which applies to treatment of both epileptic and non-epileptic seizures

A person's seizures usually last the same length of time each time they happen and stop by themselves. However, sometimes seizures do not stop or one seizure follows another without the person recovering in between. If this goes on for longer than usual it is called status epilepticus or ‘status’. 

An International League Against Epilepsy (ILAE) task force has developed a proposed new definition of status epilepticus (SE) that puts into a framework what has been the practice for years.

While treatment for SE is typically started at 5 to 10 minutes, the official definition of SE had stated a time of 30 minutes before injury occurs.

"The problem has been that you had these two definitions floating around, that included 5 minutes or 30 minutes, depending on whether you were talking about when to treat or consequences", said study author Shlomo Shinnar, MD, PhD, professor of neurology and director of the Comprehensive Epilepsy Management Centre, Albert Einstein College of Medicine in New York.

The proposed new definition, published in Epilepsia, gives two time points.  The first time point indicates the earliest time when treatment should be started. The second indicates when long-term consequences, such as neuronal injury, neuronal death, alteration of neuronal networks, and functional deficits, are increasingly likely.

For example, in the case of convulsive (tonic-clonic) SE, the first time point  is at 5 minutes and the second at 30 minutes.

SE is common among patients with epilepsy, according to statistics provided by Dr Shinnar. The data show that 10 per cent to 12 per cent of patients with a first unprovoked seizure or newly diagnosed epilepsy present with SE.  As many as 40 per cent of SE cases occur in patients with epilepsy, with head trauma, meningitis, and stroke making up much of the rest.

Because so much SE is initially non–epilepsy-related, it's important for non-epileptologists, such as emergency department physicians, to know how to treat it, said Dr Shinnar.

It is hoped the new classification will help to foster better communication between clinicians and therefore better, faster treatment of patients presenting with status epilepticus.