Definitions

Infants and children can have both convulsive and non-convulsive forms of prolonged seizures. This article addresses only convulsive episodes of status epilepticus, which is strictly defined as two or more seizures occurring consecutively without an intervening period of full recovery of consciousness, or as recurrent epileptic seizures lasting for more than 30 minutes.1 Unfortunately, such a precise definition of status epilepticus, although useful for epidemiological analysis and evaluation of therapeutic interventions, conceals a sometimes frenetic approach to acute care and the urgency experienced by clinicians when confronted with a convulsing child, irrespective of how long the episode has lasted. It therefore seems more appropriate to take a pragmatic view and consider status epilepticus as the severe end of a continuum encountered during the progressive evolution of an unrelenting seizure, which heralds a potentially life threatening sequence of complications in central, metabolic, and systemic physiology (table 1).2-5 This somewhat looser approach is reflected in the paediatric literature where seizure episodes of considerably less than 30 minutes have been considered as status epilepticus.6 7

Clinical perspective

Both the clinical context and natural history of acute seizures and status epilepticus are very important considerations when evaluating choice of anticonvulsant treatment. In many parts of the world status epilepticus in childhood is often associated with fever, although there is wide variation in the proportion of patients who have this symptom (25–50%).8-10

In the UK, status epilepticus (defined as a 30 minute episode) is an infrequent occurrence. For example, Verity et al …