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A journey into the brain during an epileptic seizure: What happens in the brain during a prolonged seizure?
Epilepsy is a common condition affecting the nervous system, but status epilepticus (SE) is a medical emergency that refers to persistent seizures that may have long-term consequences. By definition, status epilepticus is classified as a seizure lasting more than five minutes, or two or more seizures occurring in the same period without return to normal consciousness. Not only is this condition dangerous, especially when treatment is delayed, but it can have profound effects on the brain.
The risk of seizures increased significantly after 30 minutes.
During status epilepticus, the functioning of the nervous system is dramatically altered. Whether it is tonic-clonic (convulsive) or nonconvulsive (nonconvulsive), the electrical activity of the brain will show abnormalities during the seizure. In tonic-clonic status epilepticus, the patient's limbs will experience rhythmic contraction and extension movements, which may pose a threat to breathing and require immediate treatment. With non-tonic status epilepticus, the patient has an altered level of consciousness for a prolonged period of time and may lack noticeable physical responses.
Non-tonic status epilepticus is often underestimated, which is of great clinical significance.
The diagnosis of status epilepticus is usually made through a battery of tests, including blood sugar tests, brain imaging and an electroencephalogram (EEG), even though in many cases the patient may also have other underlying neurological conditions. As diagnosis progresses, the medical community is also constantly exploring the causes of status epilepticus, from stroke to trauma to drug reactions, which can cause this emergency.
Only about 25% of people who experience a seizure report having a history of epilepsy, a figure that underscores the importance of diagnosing status epilepticus.
Treatment of status epilepticus
The standard initial treatment for status epilepticus is with benzodiazepines, such as lorazepam given intravenously and mecamylamine given intramuscularly, which act to suppress seizures. In addition, other antiepileptic drugs such as phenytoin or its prodrug (fosphenytoin) are often used as follow-up treatment.
Although some are emergency therapies, adding barbiturates is also an option when faced with difficult-to-treat status epilepticus. In a small number of cases, general anesthetics such as propofol may be needed to control the seizures, which often requires additional breathing support.
Prognosis and epidemiology
For patients with status epilepticus for the first time, the mortality rate is between 10% and 30%, and survivors often have varying degrees of neurological dysfunction. An estimated 40 cases of status epilepticus occur in the United States each year, with higher rates in certain groups, such as the elderly or those with underlying neurological conditions.
The discussion of status epilepticus is not only an understanding of the physiological process, but also a mirror for reflecting on the entire medical system.
Although clear management algorithms have been widely discussed, there remains some controversy regarding the most effective treatment. New research directions will focus on discovering more effective drugs and understanding the root causes of status epilepticus. In this field full of unknowns, have you ever thought about how to make more people understand the seriousness of status epilepticus?
