What causes status epilepticus (SE)?

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

Etiologically, SE can be imperfectly divided into 3 groups. SE can represent an exacerbation of a pre-existing seizure disorder, the initial manifestation of a seizure disorder, or an insult other than a seizure disorder.

In patients with known epilepsy, the most common cause is a change in medication; the change may be directed by physician (eg, placing the patient on nothing-by-mouth [NPO] status before surgery) or may be due to abrupt cessation on the patient’s part, whether intentional or unintentional.

A myriad of other conditions may precipitate SE, including toxic or metabolic causes and anything that might produce cortical structural damage, as follows:

In more recent series of SE, HIV infection and use of illicit drugs were reported with increased frequency.

Causes of SE vary significantly with age. DeLorenzo et al reported that in patients younger than 16 years, the most common cause was fever and/or infection (36%); in contrast, this accounted for only 5% of SE in adults. [32] In adults, the most common precipitant was cerebrovascular disease (25%), whereas this factor caused only 3% of pediatric cases.

In a more refined study that focused on children, Shinnar et al found that in children younger than 2 years with SE, more than 80% of cases were of febrile or acute symptomatic origin. [33] In contrast, cryptogenic and remote symptomatic causes were more common in older children than in younger children.


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