Status epilepticus is often defined as continuous seizure activity or periodic seizures that last 30 minutes or more without recovery to baseline consciousness between seizures. If a patient has been seizing for 30 minutes, however, valuable time for treatment has been lost. It should therefore be considered a retrospective diagnosis. Every emergency department should have a published protocol or critical pathway for treating status epilepticus in adults and children,2 and this protocol should be initiated for every acutely seizing patient. The protocol is then aborted when seizing stops and the patient's condition comes under control.

Nonconvulsive status epilepticus (NCSE), in which there may be few or no outward signs that the patient is seizing, differs from the acute, life-threatening emergency of convulsive status13 with regard to the urgency and aggressiveness of treatment. It is more commonly a concern in the intensive care unit.

The clinical outcome in status epilepticus is determined by its cause.12 Patients with easily treatable toxic, metabolic, or other nonstructural causes of status epilepticus usually experience a good clinical outcome. Those with devastating structural, infectious, or other catastrophic causes usually have a poor prognosis for meaningful recovery.

The most common cause of status epilepticus in individuals with epilepsy is acute medication withdrawal related to noncompliance.14

Adapted from: Kolb SJ and Litt B. Management of epilepsy and comorbid disorders in the emergency room and intensive care unit. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;515–535. With permission from Elsevier (

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Authored By: 
Steven J. Kolb Md PhD
Brian Litt MD
Reviewed By: 
Steven C. Schachter MD
Saturday, May 1, 2004