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Status Epilepticus
Status epilepticus (SE) is defined as an medical emergency associated with significant morbidity and mortality and is presented as a continuous seizure lasting more than 5 minutes, or two or more seizures without full recovery of consciousness between any of them. Seizure lasting longer than 30 minutes may increase the risk of long-term damage, such as more brain damage. Aggressive treatment is strongly recommended. SE is classified into two main categories - generalized convulsive and non-convulsive. Generalized convulsive status epilepticus (GCSE) is the most common and severe form. GCSE is characterized by repeated primary or secondary generalized seizures that involve both hemispheres of the brain, which results in loss consciousness. Non-convulsive status epilepticus (NCSE) is characterized by continuous "epilepticus twilight" state that produces altered consciousness and/or behavior, such as lethargy and decreased mental function.

Diagnosis
Observation, physical examination, laboratory assessment, electroencephalogram (EEG), and neurologic imaging are required for accurate diagnosis. EEG is the most important diagnostic and management tool; however, therapy should not be delayed while waiting for testing or results. The diagnosis of SE must be made after the physician has observed the seizure. Clinical presentation of SE ranges from altered consciousness, ranging from lethargy to somnolence with pronounces eyes-opening unresponsiveness and waxy rigidity. The patient should be assessed for language and cognitive abilities, and the physical and neurological examinations (motor, sensory, and reflex abnormalities, pupillary response, asymmetry, and posturing). The patient should also be examined for secondary injuries (eg, tongue lacerations, shoulder dislocations, and head and facial trauma). Hypoglycemia, hyponatremia, hypernatremia, hypomagnesemia, hypocalcemia, and renal failure all can cause seizures, and so assessment of baseline serum concentration and laboratory parameters such as hematology and chemistries (albumin, renal function, and hepatic function) may be useful.