Types of Status Epilepticus Definitions and Classification

What is status epilepticus? For all the criticisms leveled at the now-traditional definition accepted by the International League Against Epilepsy (ILAE) and based on the 1962 Marseilles conference, “a condition characterized by an epileptic seizure which is so frequently repeated or so prolonged as to create a fixed and lasting epileptic condition” (1), this definition does capture the concepts nearly everyone wants. The condition is necessarily epileptic, i.e., related to abnormal electrical activity in the brain with a clinical, and unhealthy, alteration in neurologic function. The patient in status epilepticus (SE) is clearly in a different and worse state than one who has an individual epileptic seizure only. Shorvon notes that SE is “not simply an iterative version of ordinary epilepsy” (2). Whether it is a more serious and fulminant etiology of seizures that produces their prolongation and repetition, or whether there is a fundamentally different failure of inhibition (more than occurs between a spike and a clinical seizure), the patient in status epilepticus has entered a new and worse condition. Discrete epileptic seizures come to an end, although there may be a prolonged postictal state. In SE, however, there is a definite clinical imperative to interrupt seizures because the patient may suffer grievous harm otherwise. Not only are there extensive physiologic, and sometimes pathologic, changes occurring during SE (3), but there is also a fundamentally different and urgent clinical problem for the patient and physician.