Medical Safety Issues

Status Epilepticus

Most seizures end naturally within one or two minutes, and do not pose serious health risks. However, in some cases a seizure will continue for a prolonged period, or repeat without the person regaining awareness. This is a medical emergency called status epilepticus. “Status” should always be treated by a physician.

Virtually any seizure type can occur as status. It is believed that a tonic-clonic (grand mal) seizure lasting over an hour can cause brain damage. So if a seizure goes on for more than five minutes without stopping, or repeats before the person regains full awareness, call for medical attention immediately.

More than 15% of patients with epilepsy have at least one episode of status epilepticus. One common cause is low levels of medication in the blood. That is why taking your medication is so important. (The safety of the medications themselves will be discussed in an upcoming issue of Epilepsy Matters.)

Some people are especially prone to status, or to acute repetitive seizures, also called cluster seizures (i.e. two or more seizures separated by periods of consciousness).

Sometimes care-givers can help by administering emergency medications such as diazepam (Valium) or lorazepam (Ativan). A new home therapy, fast-acting diazepam rectal gel (Diastat), is now available to stop repetitive seizures. This may also reduce risks for people who live in rural areas, long distances from emergency medical services. If you think you may need a preparation such as Diastat, consult with your physician.

SUDEP

Sudden Unexplained Death in Epilepsy or SUDEP refers to the sudden death of a person with epilepsy without determinable cause. The rate of SUDEP is estimated to be around 1 in 1,000 people with epilepsy a year, typically a young person 20 to 40 years old with poorly controlled tonic-clonic seizures. Although most SUDEP deaths are not witnessed, there is evidence that SUDEP may often be preceded by a seizure.

Because the exact cause of SUDEP is so far unknown, it is still impossible to prevent. Here are some suggested ways to perhaps reduce the risk:

• Take your anticonvulsant medications as directed.
• Try to achieve the best seizure control. Live a healthy lifestyle, learn stress management and adopt a regular sleep pattern.
• Avoid the use of drugs, excessive use of alcohol and your seizure triggers.
  
• Family members can learn CPR.
  

Remember, it is important for people with uncontrolled epilepsy to balance the awareness of their slightly increased risk of death with the need to live as normal a life as possible. There are usually very few things that people with epilepsy cannot do.