Seizures and Status Epilepticus

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About Seizures and Status Epilepticus

Seizures are episodes of abnormal electrical activity in the brain that can manifest as altered consciousness, motor movements, or sensory disturbances. Status epilepticus is a neurological emergency defined as continuous seizure activity lasting more than 5 minutes or recurrent seizures without return to baseline consciousness, requiring immediate intervention to prevent permanent brain damage.

Pathophysiology

Seizures result from excessive, synchronous neuronal discharge due to imbalance between excitatory and inhibitory neurotransmitters, often involving disrupted GABA and glutamate signaling. Status epilepticus occurs when normal seizure termination mechanisms fail, leading to prolonged electrical storms that cause metabolic derangement, hyperthermia, and potential irreversible neuronal injury through excitotoxicity and energy depletion.

Clinical Reasoning

Rapid recognition and treatment of status epilepticus is critical as mortality and morbidity increase significantly after 30 minutes of continuous seizure activity. First-line management includes securing airway, administering benzodiazepines (lorazepam or midazolam), and identifying underlying causes such as medication non-compliance, metabolic disorders, or CNS infections. Refractory cases may require anesthetic agents and continuous EEG monitoring in intensive care settings.

References

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Imaging Reasoning

CT Head (acute) → MRI Brain

Key imaging focus: CT for acute (hemorrhage, mass); MRI epilepsy protocol for structural causes

📚 Radiopaedia Cases →
  1. Seizures. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK430765/
  2. AAN/AES Status Epilepticus Guidelines. Neurology 2023. https://doi.org/10.1212/WNL.0000000000201045
  3. AES/AAN Guideline for Status Epilepticus. Epilepsy Currents. https://doi.org/10.1177/1535759720949462
  4. ILAE Classification of Epilepsies. Epilepsia. https://doi.org/10.1111/epi.13670

Related Topics

Seizure Disorders & EpilepsyStatus EpilepticusFebrile SeizuresAltered Mental StatusMeningitis