Status epilepticus can assume as many forms as there are types of epileptic seizures. From a clinical point of view, 3 types of status epilepticus have been defined: generalised tonic-clonic status epilepticus, nonconvulsive status epilepticus (absence status epilepticus and status epilepticus of complex partial seizures) and status epilepticus with partial motor symptoms.A number of precipitating factors lead to the development of status epilepticus. These include fever, alcohol abuse, sleep deprivation, medication with proconvulsive drugs and noncompliance with antiepileptic medication. Most often, status epilepticus develops because of a combination of these factors.Status epilepticus may arise from a prolonged seizure or evolve from a series of seizures. The syndrome may occur in patients with chronic epilepsy, without brain damage or with acute brain damage.The clinical symptomatology varies during the course of status epilepticus, especially in nonconvulsive status epilepticus. In generalised convulsive status epilepticus, the intensity of seizures decreases during the course of the syndrome.The outcome of status epilepticus may be complicated by neuropsychiatric deficits. A lethal outcome is also possible and usually occurs in the post-status phase. The prognosis of status epilepticus strongly depends on the interval to the onset of therapy and the efficacy of the treatment. The aetiology of any underlying disease also affects the prognosis. Long term treatment with antiepileptic medication and prevention of precipitating factors are helpful in preventing a relapse of status epilepticus.First-line agents for the treatment of generalised tonic-clonic status epilepticus are benzodiazepines and phenytoin, with phenobarbital (phenobarbitone) being used if phenytoin is ineffective. However, a single study demonstrated that phenobarbital was superior to a combination of benzodiazepines and phenytoin as first-line therapy. Phenobarbital-induced respiratory depression may occur but is of consequence only at high dosages. If these drugs fail to prevent status epilepticus, anaesthesia with pentobarbital (pentobarbitone) or thiopental sodium (thiopentone) is recommended. There is limited experience with the use of other drugs in the treatment of status epilepticus. Lidocaine (lignocaine), isoflurane, propofol, chloral hydrate, paraldehyde and clomethiazole (chlormethiazole) have been used.Therapy of partial status epilepticus is similar to that of generalised tonic-clonic status epilepticus, with benzodiazepines and phenytoin being the drugs of choice. Anaesthesia is only used when focal seizures of status epilepticus with motor symptomology evolve to generalised tonic-clonic status epilepticus. Benzodiazepines are used in the treatment of absence status epilepticus.
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