I. Partial Status Epilepticus

II. Generalized Status Epilepticus

1. Prolonged Febrile Seizure

• most common cause of status

2. Idiopathic Status Epilepticus

• status develops in the absence of an underlying central nervous system (CNS) insult or with the sudden withdrawal of anticonvulsants

3. Symptomatic Status Epilepticus

• status develops in association with a longstanding neurologic or metabolic disorder
• associated with a higher mortality than the first two

1. Simple Partial

• prolonged focal seizure or very frequent recurrent focal seizures associated with preservation of consciousness
• Rasmussen or Lafora body encephalitis may be the cause

2. Epilepsia Partialis Continua

• a form of SPS with focal motor phenomena
• clonic jerking or twitching of a limited part of the body
• lasts weeks -> months (mean of 25 months)
• may lead to progressive hemiparesis
• very difficult to treat

3. Complex Partial (Psychomotor)

• a prolonged episode of mental confusion that may be associated with psychomotor or psychosensory symptoms
• may last for hours or days

4. Tonic-Clonic (Grand Mal)

• onset with a brief tonic phase followed by a prolonged clonic phase
• usually serial but can be continuous
• generalized onset or partial onset with secondary generalization
• generalized onset type most common type of status in children

5. Tonic

• tonus may be either extensor and/or flexor but usually with flexion of the upper extremities and extension of the lower
• if tone is low then may be difficult to recognize status
• typically occurs in children with secondarily generalized epilepsies

6. Clonic

• prolonged clonic seizure(s) without a tonic phase at the onset
• clonic activity:
  • lower amplitude than seen with a typical tonic-clonic seizure
  • often asymmetrical and arrhythmic
• risk factors:
  • infants and children <5 years
  • fever
  • underlying disorder (meningitis, chronic encephalopathy)
• if idiopathic then the prognosis is good

7. Myoclonic

• bilateral myoclonic jerks at irregular intervals with preservation of consciousness (able to recall events during seizures)
• rare, occurs primarily in children and adolescents

8. Typical Absence (Petit Mal)

• prolonged mental confusion (very prolonged absence seizure) with limited interaction skills with examiner
• during seizures have competent motor abilities with no evidence of motor seizure activity
• occurs most commonly in older children and adolsecents
• have classic 3 Hz spike and wave abnormalities

9. Atypical Absence (Minor Motor)

• prolonged mental confusion with occasional myoclonus or atonic seizures
• seen in Lennox-Gastaut syndrome (minor motor epilepsy)
• poor prognosis

I. INITIAL MANAGEMENT

II. STOP THE SEIZURE

• try lorazepam, diazepam, or paraldehyde first (up to 1-2 repeats) and if the seizure persists then use the longer-acting anticonvulsants (phenytoin, phenobarbital)
• in neonatal seizures, use phenobarbital as the first line of therapy
• if the patient is already on phenytoin or phenobarbital, use booster doses of 5 mg/kg and subsequent doses may be based on anticonvulsant levels
• the intra-osseous route should be used only after the sublingual and rectal routes have failed to stop the seizure and an IV cannot be established (lorazepam, diazepam, phenytoin, and phenobarbital can be given by intra-osseous)

III. CONTROL ICP (if seizure >60 minutes)

1. Canadian Paediatric Society Statement; Management of the Paediatric Patient with Generalized Convulsive Status Epilepticus in the Emergency Department. 1995.