Status epilepticus is a dangerous brain condition that happens when a person has seizures that last too long or happen too quickly in sequence. Any condition that can cause a seizure can lead to SE. This condition is treatable, and many people who’ve had it survive and recover if they receive medical attention quickly.
Status epilepticus (SE) is when a person has a continuous seizure or multiple seizures without enough time to recover between them. While it’s more likely to happen to people with epilepsy, many conditions can cause continuous or repeated seizures in people who don’t have epilepsy. This condition is a life-threatening medical emergency and needs immediate medical care.
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Seizures can happen to anyone under the right circumstances, and the same is true of SE. But people with certain characteristics are more likely to have it. Those characteristics are:
SE is uncommon overall but is one of the most common brain-related medical emergencies. Experts estimate there are between 7 and 40 cases per 100,000 people each year. That means there are between 23,000 and 131,800 cases annually in the U.S. About 2% of seizures turn into SE and around 23% of new seizure cases involve status epilepticus.
While SE originates in your brain, it has dangerous effects on multiple systems throughout your entire body. To better understand how SE works, it helps to understand what a seizure is.
Your neurons can’t handle extended periods of uncontrolled activity. Just as too much electrical current can overload and damage an electronic device, uncontrolled seizure activity during SE can damage your neurons. That kind of damage is often permanent, which means you’ll lose abilities that affected areas of your brain once controlled.
SE can involve widespread, uncontrolled muscle movements throughout your body. This causes your body temperature to go up and your muscles to tire out. Your body can try to compensate for this by releasing chemicals into your blood to help keep you going, but that only helps for a limited time.
If SE continues for too long, it can affect the following systems and processes in your body:
The symptoms of SE depend on the area of the brain affected. Depending on where they happen in your brain, you can have different types of seizures. And because there are different seizure types, there are also different subtypes of SE. They are:
Seizures are the only cause of SE, and there are two main ways that seizures can happen:
Seizures can happen for many different reasons, and certain causes are also why people of certain ages have a higher risk of SE. Those specific causes are:
Other causes of seizures include:
A healthcare provider can tentatively diagnose SE based on a person’s seizure symptoms and how long they have a seizure or if they have more than one seizure without enough time to recover between them. But it’s also important for providers to find out why the person had a seizure that led to SE. That usually takes a combination of methods.
An electroencephalogram (EEG) is the gold standard for any seizure diagnosis, including SE. This diagnostic test involves sensors coated in a sticky, electrically conductive gel and placed on your head. The gel helps the sensors pick up the electrical activity of your brain.
By examining the patterns in your brain activity, providers can definitively diagnose a seizure. If the person has an ongoing seizure or has multiple seizures in a row, a provider can diagnose SE. EEG is especially important when a person has nonconvulsive SE.
However, it’s also important for a provider to determine if the person’s seizures are provoked or unprovoked. Doing that can involve several different tests and exams, including:
Your healthcare provider might also recommend other tests. Possible reasons include whether you have (or they suspect you have) any injuries, your health history, the type of seizure you had and more. Your provider (or someone you choose to make medical decisions for you) is the best person to tell you what kind of tests they recommend and why.
Treating SE involves a combination of techniques. That’s because SE affects your entire body, with the potential to cause serious or life-threatening complications. These methods include:
When SE resists treatment, it’s known as refractory SE. But there are still treatment options available.
Medications are key in stopping seizure activity in your brain. They can also treat other complications that SE can cause, such as heart rhythm problems.
The most likely medications for directly stopping seizures include:
Intubation means inserting a tube down a person’s trachea (windpipe). That tube ensures that a person’s windpipe stays open. It also allows medical personnel to use manual resuscitation bags or a ventilator to breathe for you.
When a person has a provoked seizure, treating the underlying cause can sometimes be enough to stop the seizures from happening. Some examples include seizures due to medications, poisons and toxins, withdrawal from alcohol or recreational drugs, metabolic problems like too much or too little sodium or potassium, etc.
Another approach is to keep seizures from happening so they don’t cause SE again. Some of the most common ways to prevent seizures (or make them less severe or happen less often) include:
Depending on your specific case and circumstances, other treatments and techniques are also possible. Your healthcare provider (or someone authorized to make medical decisions for you) is the best person to explain to you what treatments they recommend and why.
The complications or side effects possible with treatments for SE depend on many factors. These include:
Your healthcare provider is the best person to explain the likely or possible complications and side effects. They can also offer guidance on preventing or minimizing those side effects and complications when possible.
SE is a life-threatening medical emergency. People who have it can’t take care of themselves or do anything to stop the seizure directly. The only safe way to diagnose and treat them is in an emergency room — or another type of emergency medical setting — with the necessary equipment and supplies. Because of those factors, this condition is always a reason to call 911 (or your local emergency services number) for immediate medical attention.
The time it takes to recover from SE and treatments for it can depend on many factors. The most important factors that determine recovery time are what caused your status epilepticus and how long your status epilepticus lasted. Your healthcare provider is the best person to tell you the timeline for recovery in your case.
Seizures can happen for many reasons, many of which happen unpredictably. Because of this, there’s no way to prevent seizures and SE completely. But there are ways to reduce your risk of having a seizure. Doing so makes it less likely that you’ll have a seizure that can turn into SE. Ways you can reduce your chances of having a seizure include:
If you have SE, you’ll lose consciousness as the seizure disrupts how your brain works. During a seizure, the malfunctions in your brain keep you from knowing what’s happening to you or taking any deliberate action. The exact effects on your body depend on the type of seizure that causes SE. People with SE may also have injuries from falling or from colliding with nearby objects and items.
SE lasts at least five minutes, and the longer a seizure lasts, the less likely it’ll stop on its own. That means that SE will most likely continue until the effects of this condition cause death.
SE is a medical emergency because it’s usually fatal without treatment. However, treatment methods have improved greatly. Today, SE on its own is only deadly in about 0.5% to 2% of cases.
In general, children and infants who have SE from febrile seizures have the best outlook. But when it happens along with more severe conditions like stroke, the risk of death goes up (either from SE or from the other conditions). That’s why the survival rate of SE is lower in adults over age 60.
Preventing seizures is a key way to take care of yourself if you have a history of SE. The most important steps you can take to prevent seizures include:
SE is a medical emergency. Since you can’t call 911 for yourself if you have SE, having someone else do it for you can make a huge difference. If you have a history of SE and a risk of it happening again, talking to your family, loved ones, coworkers and friends can help. Educating them on when to call for help could save your life or someone else’s.
If someone you’re with has a seizure that lasts more than five minutes or has more than one seizure without recovering between them, call 911, or your local emergency services number, immediately. The faster a person receives treatment for SE, the better the odds of a good outcome.
If you’re with someone who’s having a seizure, there are several things you can do as part of seizure first aid. If a seizure lasts more than five minutes or a person doesn’t fully recover before they have another seizure, call 911 (or your local emergency services number) immediately.
Here are some things you should and shouldn’t do when someone is having a seizure:
Many people experience symptoms that are warning signs of a seizure that’s about to happen. If you think you’re going to have a seizure, you can do the following to prepare and protect yourself:
A note from Cleveland Clinic
Status epilepticus (SE) is a life-threatening medical emergency that happens when a seizure lasts more than five minutes, or when you don’t have enough time to recover fully between seizures. Being at risk for seizures and SE or watching a loved one having a prolonged seizure can be a source of anxiety and fear. However, with fast care, many people survive and recover from this condition. With ongoing medical care, medications and other treatment approaches, many people with a history of SE can recover and return to living their lives.
Last reviewed by a Cleveland Clinic medical professional on 02/13/2023.
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