Chapter 106 - The causes of convulsive status epilepticus in adults

Summary

This chapter presents the epidemiology, clinical features, diagnosis, and treatment for convulsive status epilepticus (CSE) in adults. In adults, the most common etiologies are low antiepileptic drug levels, remote symptomatic etiologies, and stroke. Generalized convulsive SE is typically manifested as generalized tonic stiffening, followed by rhythmic jerking movements of the extremities that are usually symmetric. Patients with idiopathic generalized epilepsy and myoclonic SE may initially retain consciousness between recurrent myoclonic jerks, but awareness becomes altered as the SE progresses. Convulsive SE may occur in adults with Lennox-Gastaut syndrome, and in those with epilepsy associated with ring chromosome 20, but non-convulsive SE is more common. Imitators of partial convulsive SE include hemifacial spasm, asymmetric tremor, myoclonic jerks, tics, focal dystonia, paroxysmal nocturnal dyskinesia, and blepharospasm. Several randomized blinded trials of treatments for SE have compared lorazepam and diazepam in the treatment of SE, and found a higher response rate for lorazepam.