Status epilepticus and serial epilepsy

Status epilepticus

Status epilepticus occurs most commonly in tonic-clonic seizures and is a serious form of epilepsy in which there is persistent epileptic activity for more than 30 minutes, or in which there are successive seizures without recovery of consciousness in between.

‘Status epilepticus’ may be divided into two groups -:

• Those where the ‘status’ was precipitated by an avoidable cause e.g. sudden withdrawal of anticonvulsant medication or alcohol withdrawal in some adolescents. This may be termed as ‘explained status epilepticus’.
• Those where there is no identifiable cause i.e. the child may have poorly controlled epilepsy. This may be termed as ‘unexplained status epilepticus’.

‘Status epilepticus’ is the most serious event children with epilepsy are likely to encounter and has a significant mortality rate. The risk of recurrence of status epilepticus will depend on whether there are any avoidable precipitating factors e.g. sudden withdrawal of alcohol or medication (explained) or not (unexplained).

If no cause is found then recurrence cannot be excluded. The risk of recurrence decreases significantly with the passage of time and is minimal after 12 months from the date of the last episode.

Serial Epilepsy

Serial epileptic attacks (also known as “closely-spaced seizures”, or “cluster attacks”) should be distinguished from ‘Status epilepticus’.

In serial epilepsy although attacks are very frequent, the person recovers consciousness in between attacks. It is not associated with the same risks as ‘Status epilepticus’, in which the attacks occur in such rapid succession that recovery of consciousness between the episodes does not occur.