Generalized convulsive status epilepticus

Generalized convulsive status epilepticus (GCSE) is a medical emergency that may be associated with severe neuronal injury. The mortality attributable to GCSE ranges from 3 to 35%. The disorder occurs most frequently in the young and the old extremes of the population. GCSE commonly occurs in patients with no history of seizures or epilepsy. The morbidity associated with status epilepticus is related to the underlying precipitating factors, age of the patient, and duration of seizure activity. Morbidity and mortality are highest in elderly patients and those with acute symptomatic seizures--for example, GCSE related to anoxia or cerebral infarction. Mortality is lowest among pediatric patients and patients with unprovoked seizures or GCSE related to low antiepileptic drug levels. Intravenously administered diazepam or lorazepam and phenytoin remain the first-line therapy for GCSE. More than half the patients will respond to initial treatment. Patients with refractory status epilepticus require a physician with expertise in epilepsy. Treatment options include pentobarbital, high-dose phenobarbital, or inhalation anesthetic agents.