From the Guidelines
Status epilepticus is primarily caused by clinical conditions such as infection, hemorrhage, or trauma, as well as failure of first-line treatment with optimal dosing of benzodiazepines in patients with epilepsy. The causes of status epilepticus can be diverse and include various clinical conditions. According to 1, up to 5% of adults with epilepsy will have one episode of status epilepticus in their lifetime, and it can also occur in patients without epilepsy due to conditions such as infection, hemorrhage, or trauma.
Some of the key causes of status epilepticus include:
- Infection, such as systemic or CNS infection
- Hemorrhage
- Trauma
- Hypoglycemia
- Hyponatremia
- Hypoxia
- Drug toxicity
- Withdrawal syndromes
- Ischemic stroke
- Intracerebral hemorrhage
It is essential to identify and address the underlying cause of status epilepticus, as condition-specific treatment should be given if a provoking cause is discovered 1. Additionally, patients who continue to have generalized convulsive status epilepticus should be given an additional anticonvulsant agent, and simultaneous search for treatable causes of status epilepticus should be conducted.
From the FDA Drug Label
Because status epilepticus may result from a correctable acute cause such as hypoglycemia, hyponatremia, or other metabolic or toxic derangement, such an abnormality must be immediately sought and corrected. The causes of status epilepticus include:
- Metabolic derangements such as hypoglycemia and hyponatremia
- Toxic derangements These causes should be immediately sought and corrected in patients with status epilepticus 2 2
From the Research
Causes of Status Epilepticus
The causes of status epilepticus can be varied and complex. Some of the possible causes include:
- Acute neurologic conditions such as meningitis, encephalitis, or stroke 3
- Complicated febrile seizures 3
- Intractable epilepsy 3
- Degenerative diseases 3
- Intoxication 3
- Abrupt withdrawal of antiepileptic treatment 4
- Infections 4
- Alcohol abuse 4
- Use of convulsive drugs 4
- Cerebral trauma 4
- Frontal brain tumors 4
- Cerebral arteriosclerosis or other vascular disorders 4
- Anaphylaxis 4
- Stroke, which is a major cause of status epilepticus in nonepileptic patients 4
- Immune-mediated, paraneoplastic or infectious encephalitis and anoxic brain injury, which can be targeted with etiology-guided management 5
Underlying Conditions
Status epilepticus can occur in both epileptic and nonepileptic patients. In epileptic patients, it is often due to irregular treatment or abrupt withdrawal of antiepileptic medication 4. In nonepileptic patients, it is often caused by an underlying condition such as stroke or cerebral trauma 4. The prognosis of status epilepticus depends on the underlying cause, the time it takes to stop the seizures, and the age of the patient 4.
Clinical Characteristics
The clinical characteristics of status epilepticus can vary depending on the type of seizure and the underlying cause. Convulsive status epilepticus is the most common type and can be diagnosed using clinical features alone 6. Non-convulsive status epilepticus, on the other hand, requires confirmation by electroencephalogram 6. The treatment and outcome of status epilepticus depend on the clinical characteristics and the underlying cause 7, 3, 4, 5, 6.