Comparison of status epilepticus with prolonged seizure episodes lasting from 10 to 29 minutes

Purpose: Status epilepticus (SE) is a major medical and a neurologic emerge ncy associated with significant morbidity and mortality. The current defini tion of SE is continuous seizure activity or intermittent seizure activity without regaining consciousness, lasting greater than or equal to 30 min. E pilepsy monitoring unit data indicate that many seizures self-terminate wit hin minutes. Thus consideration was recently given to include seizure episo des lasting greater than or equal to 10 min in the definition of SE. Becaus e no large studies have been conducted on seizures lasting 10-29 min, this study was initiated to compare cases of SE and 10 to 29-min seizure episode s seen within the same period. Methods: Patients seen at the Medical College of Virginia Hospitals of Virg inia Commonwealth University over the same 2-year period were studied. Two hundred twenty-six prospective SE cases (91 children and 135 adults) and 81 retrospective 10- to 29-min seizure episodes (31 children and 50 adults) w ere compared. A standardized data-entry-form system was compiled on each pa tient and was used to evaluate the data collected. Results: The 10- to 29-min seizure patients and the SE cases had similar de mographic characteristics, such as sex, race, and age, and also had similar etiologies. The majority (93%) of SE cases required anticonvulsant (AED) t reatment to control and stop seizure activity. In the 10- to 29-min group, 43% stopped seizing spontaneously, and the remainder (57%) required AED tre atment to stop seizure activity. The mortality for the SE patients was 19% compared with 2.6% for 20- to 29-min group (p < 0.001). In the 10- to 29-mi n group that stopped seizing spontaneously, the mortality was 0. In the 10- to 29-min patients that required AED treatment, the mortality was 4.4%. Conclusions: The results demonstrate that a significant number of patients experience seizure activity lasting from 10- to 29-min. Approximately half of these seizure events stopped spontaneously and did not require AED treat ment. The other half of the patients responded quickly to medications and s topped seizing before the 30-min definition for SE. The overall mortality o f this group was significantly lower than that of the patients with SE. The results demonstrate that further studies on the 10- to 29-min seizure grou p are needed to differentiate seizures that will stop spontaneously and tho se that will only stop with AED treatment. Because almost half of the prolo nged seizures stopped spontaneously, further studies are needed before incl uding prolonged seizure activity in the definition of SE.