What Is Status Epilepticus?

Most seizures last less than 2 minutes. But sometimes they don’t stop there – or they come one after the other, giving the person suffering from them no chance to recover. “Status epilepticus” literally means a continuous state of seizure.

Status epilepticus (SE) is a medical emergency that starts when a seizure hits the 5-minute mark (or if there’s more than one seizure within 5 minutes). After this point, it becomes less and less likely that doctors will be able to stop the seizure with medication. The risk of death also goes up the longer a seizure continues.

What Happens in Status Epilepticus?

There are two main forms of SE -- convulsive and nonconvulsive. The convulsive type is more common and more dangerous. It involves tonic-clonic seizures. You may have heard these referred to as “grand mal” seizures. It looks like this:

  • In the tonic phase (which usually lasts less than 1 minute), your body becomes stiff and you lose consciousness. Your eyes roll back into your head, your muscles contract, your back arches, and you have trouble breathing.
  • As the clonic phase starts, your body spasms and jerks. Your neck and limbs flex and relax rapidly but slow down over a few minutes.
  • Once the clonic phase ends, you might stay unconscious for a few more minutes. This is the postictal period.

Because there are two phases that happen before the postictal period, it can be hard to tell what’s happening if you witness one of these seizures. To be safe, call 911 if the tonic phase – the first phase -- lasts for more than 5 minutes, or if another seizure seems to start right after one finishes.

In a nonconvulsive SE episode, you don’t lose consciousness but are in an “epileptic twilight” state. There might not be any shaking or seizing at all, so it can be very hard for someone observing you to figure out what’s happening. A nonconvulsive seizure can turn into a convulsive episode.

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Who Is Likely to Have One?

Only about 25% of people who have seizures or SE have epilepsy. But 15% of epileptic people will have an SE episode at some point. Most often, it happens when they’re not controlling their condition with medications.

Most cases of SE happen to children under age 15 who have seizures brought on by high fever, and adults over 40 (most often because of strokes).

Other things that might lead to SE include:

When to Call 911

Convulsive status epilepticus is a medical emergency. Get medical help right away if you have a convulsive seizure that lasts more than 5 minutes.

Failure to get treatment right away could result in brain damage or even death.

WebMD Medical Reference Reviewed by Neil Lava, MD on March 06, 2019

Sources

SOURCES:

Epilepsy Foundation: “Status Epilepticus.”

Johns Hopkins Medicine: “Status Epilepticus,” “Tonic-Clonic (Grand Mal) Seizures.”

Epilepsy Foundation of Greater Chicago: “Status Epilepticus.”

Epilepsy Currents: “Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society.”

Medscape: “Status Epilepticus.” 

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