Clinical Presentation

The clinical presentation of status epilepticus can be divided into early and late signs and symptoms. Seizure semiology, mental status changes, vital sign abnormalities, and potential complications reflect the progression of this dynamic disease state.

• Symptoms:
  • Impaired consciousness ranging from confusion to coma
  • Amnesia for the seizure
  • Muscle contractions and unusual body movements
  • Involuntary passage of urine or feces
• Early signs:
  • Generalized convulsions with rigidity and jerking
  • Tongue biting, head/eye deviation
  • Injuries related to seizures like head trauma, shoulder dislocations
  • Low grade fever may be present
• Late signs:
  • Ongoing seizures may progress to subtle muscle twitching or eye deviation
  • Post-ictal state with unresponsiveness, lethargy, sleepiness
  • Respiratory failure requiring intubation and mechanical ventilation
  • Hemodynamic instability – hypotension, arrhythmias
  • Hyperthermia from excessive muscle activity
  • Rhabdomyolysis and myoglobinuria
  • Aspiration pneumonia, pulmonary edema
  • Metabolic derangements like lactic acidosis, hypoglycemia
• Risk factors:
  • History of epilepsy – especially uncontrolled seizures
  • Prior episodes of status epilepticus
  • Recent changes in antiseizure regimen
  • Medication non-adherence
  • Alcohol or sedative withdrawal
  • Metabolic disorders like renal failure, liver failure
  • CNS infections like meningitis, encephalitis
  • Stroke, CNS tumor, head trauma
  • Drug overdose, toxin exposure

The progression of status epilepticus from early generalized convulsions to subtle seizure manifestations and post-ictal impairment along with the potential for systemic complications underscore the need for prompt recognition and treatment.