How is status epilepticus (SE) classified?

Updated: Feb 13, 2018
  • Author: Julie L Roth, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

The term status epilepticus may be used to describe continuing seizure of any type.

The predominant type of seizure further refines the definition of SE, and several classification schemes have been proposed.

Categorization of SE cases is no simple matter because they often exhibit characteristics of both focal and generalized processes. Considerable literature has been devoted to this question over the last 30 years, beginning with Geier et al in 1976, [17] Ellis and Lee in 1978, [18] and Niedermeyer et al in 1979. [19]

Several investigators have suggested that the bulk of these indeterminate examples are instances of focal onset episodes of status that have secondarily generalized, in the same manner as many focal onset seizures. EEGs of patients with these conditions fail to capture the onset of status; therefore, this critical element is lost.

Some of these instances are characterized by diffuse, slow (< 3 Hz) spike-and-wave activity, albeit with focal predominance. In many instances, interictal recordings demonstrate focal discharges that further implicate a focal process. Whether such cases are best grouped with focal status remains controversial.

Luders and Rona [1] have suggested a detailed semiologic classification along 3 axes: (1) the type of brain function predominantly compromised, (2) the body part involved, and (3) The evolution over time. Celesia [20] and Treiman [21] proposed simpler schemes, which are more useful than other systems for emergency treatment decisions.

The Treiman classification is as follows:

  • Generalized convulsive SE

  • Subtle SE

  • Nonconvulsive SE (including absence SE and complex partial SE)

  • Simple partial SE


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