Electrical storm in the brain: Visualizing Status Epilepticus

Seizure SOS: Understanding Status Epilepticus and How to Respond

Theo Raines in Health & Wellness August 2025 • 4 min read.

"New Research Sheds Light on Incidence, Causes, and Outcomes of Prolonged Seizures"

Imagine a seizure that doesn't stop, lasting for more than five minutes of continuous seizure activity or frequent recurrent seizures without regaining consciousness in between. This is status epilepticus (SE), a life-threatening condition demanding immediate medical attention. Recent research is changing how we understand and approach this critical situation.

Once defined by a 30-minute threshold, status epilepticus is now recognized earlier, thanks to the International League Against Epilepsy (ILAE). The ILAE proposed in 2015 that convulsive SE (CSE, or bilateral tonic-clonic SE) be defined as longer than 5 minutes and 10 minutes for focal SE and absence SE, The revised definition emphasizes acting quickly to prevent potentially irreversible brain damage and improve patient outcomes.

The study, published in 'Epilepsia', provides critical insights into the incidence, causes, and outcomes of status epilepticus using the updated ILAE 2015 criteria. The findings highlight the importance of prompt diagnosis, appropriate classification, and tailored management strategies to improve patient outcomes.

Decoding Status Epilepticus: Incidence, Causes, and Outcomes

Electrical storm in the brain: Visualizing Status Epilepticus

A groundbreaking population-based study conducted in Salzburg, Austria, has shed new light on the epidemiology of status epilepticus in adults, utilizing the International League Against Epilepsy (ILAE) 2015 definition and classification. The research, which analyzed data from 221 patients diagnosed with status epilepticus between 2011 and 2015, revealed key insights into the incidence, causes, and outcomes associated with this life-threatening neurological condition.

The study found an age- and sex-adjusted incidence of a first episode of SE, NCSE, and SE with prominent motor phenomena (including CSE) was 36.1 (95% confidence interval [CI] 26.2-48.5), 12.1 (95% CI 6.8-20.0), and 24.0 (95% CI 16.0-34.5; including CSE 15.8 [95% CI 9.4-24.8]) per 100 000 adults per year, respectively. This is a notable increase compared to previous estimates that relied on older diagnostic criteria.

The findings underscore several key points:

Increased Incidence: The adoption of the ILAE 2015 definition, along with greater availability of emergency EEG services, has led to a higher detection rate of status epilepticus cases.
Impact of Semiologic Evolution: The way a seizure evolves—whether it starts as convulsive and transitions to nonconvulsive, or vice versa—significantly affects the outcome.
Level of Consciousness Matters: Patients who remain fully awake or only experience reduced cognition during status epilepticus have better outcomes compared to those with impaired consciousness (somnolence, stupor, or coma).
Subtypes of SE: Nonconvulsive SE (NCSE) had an annual incidence of 12.1 per 100,000 adults, while SE with prominent motor phenomena occurred at a rate of 24.0 per 100,000.

The research also highlighted the importance of etiology (the cause of status epilepticus) in determining patient outcomes. Symptomatic etiologies, such as cerebrovascular events, trauma, and tumors, were common causes of SE. The study also distinguished between acute, remote, and progressive etiologies, with each category carrying different prognostic implications.

The Path Forward: Improving Outcomes in Status Epilepticus

This study provides valuable insights into the epidemiology, classification, and management of status epilepticus. By utilizing the updated ILAE 2015 definition and classification, researchers have gained a more accurate understanding of the incidence and subtypes of SE, as well as the impact of semiology and level of consciousness on patient outcomes. These findings underscore the need for prompt diagnosis, appropriate classification, and tailored treatment strategies to improve outcomes in this critical neurological condition. Further research is needed to explore the underlying mechanisms driving the evolution of semiology and to identify novel therapeutic targets for status epilepticus.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1111/epi.14607, Alternate LINK

Title: Epidemiology Of Status Epilepticus In Adults: A Population-Based Study On Incidence, Causes, And Outcomes

Subject: Neurology (clinical)

Journal: Epilepsia

Publisher: Wiley

Authors: Markus Leitinger, Eugen Trinka, Giada Giovannini, Georg Zimmermann, Cristina Florea, Alexandra Rohracher, Gudrun Kalss, Caroline Neuray, Rudolf Kreidenhuber, Julia Höfler, Giorgi Kuchukhidze, Claudia Granbichler, Judith Dobesberger, Helmut F. Novak, Georg Pilz, Stefano Meletti, Uwe Siebert

Published: 2018-11-26

Everything You Need To Know

What is status epilepticus (SE), and why is it considered a critical medical condition?

Status epilepticus (SE) is a life-threatening neurological emergency characterized by either a seizure lasting longer than five minutes or recurrent seizures without regaining consciousness between them. Prompt recognition and intervention are critical to prevent irreversible brain damage and improve patient outcomes. The ILAE definition has shifted the focus to earlier intervention, acknowledging the need to act quickly.

What were the key findings of the 'Epilepsia' study regarding the incidence of different types of status epilepticus (SE) using the International League Against Epilepsy (ILAE) 2015 definition?

The 'Epilepsia' study, conducted in Salzburg, Austria, utilized the International League Against Epilepsy (ILAE) 2015 definition. It revealed that the age- and sex-adjusted incidence of a first episode of SE was 36.1 per 100,000 adults per year. NCSE occurred at a rate of 12.1 per 100,000 adults, while SE with prominent motor phenomena, including CSE, occurred at a rate of 24.0 per 100,000.

How do the semiologic evolution of a seizure and the level of consciousness impact outcomes in status epilepticus (SE)?

The evolution of seizure activity, whether it starts as convulsive and transitions to nonconvulsive or vice versa, significantly influences patient outcomes in status epilepticus (SE). Additionally, a patient's level of consciousness during SE is a crucial factor; those who remain awake or experience only reduced cognition tend to have better outcomes compared to those with impaired consciousness. Understanding these factors helps tailor management strategies.

What are the common causes (etiologies) of status epilepticus (SE), and how does identifying the specific etiology help in managing the condition?

Symptomatic etiologies, such as cerebrovascular events, trauma, and tumors, are frequently identified as underlying causes of status epilepticus (SE). Differentiating between acute, remote, and progressive etiologies is essential because each category carries different implications for patient prognosis and management. Accurately determining the cause guides appropriate treatment and influences expectations for recovery.

How has the updated International League Against Epilepsy (ILAE) 2015 definition affected the detection and understanding of status epilepticus (SE)?

The updated International League Against Epilepsy (ILAE) 2015 definition for status epilepticus (SE) emphasizes earlier intervention by reducing the threshold for diagnosis. This, along with increased availability of emergency EEG services, has led to a higher detection rate of SE cases. It is likely some cases previously not identified as SE are now being diagnosed, underscoring the importance of timely diagnosis and intervention to improve patient outcomes.