Can status epilepticus sometimes just be a long seizure?

Commentary Status epilepticus (SE) is a grave, life-threatening neurological emergency requiring rapid administration of definitive therapy to avoid irreversible brain injury (1), but it seems paradoxical that many children who experience it do surprisingly well. For instance, children who experience SE are no more likely to go on to develop chronic epilepsy than those who experience an ordinary, self-limited first seizure (2). Although prolonged seizures may be associated with subsequent development of hippocampal sclerosis (3), and a history of SE predicts a lower chance of seizure freedom after temporal lobectomy (4), nonetheless , children with SE and epilepsy were found to have only a modestly lower chance of achieving seizure remission than others with epilepsy in one prospective population-based study (5). While it is not surprising that individual patients experience cognitive deterioration after SE (6), this has not been proven for larger samples of patients. How often does SE, a potentially malignant phenomenon, have an apparently benign outcome? This question is addressed by this study from the Camfields using the Nova Scotia Childhood Epilepsy population-based cohort. That province has a central EEG reading facility. Based on the assumption that children will receive an EEG for new onset of an unexplained seizure, these EEG records were used to identify all children with newly diagnosed epilepsy between 1977 and 1985. Contact had been maintained with these patients and their families, most recently in 2009–2011, to collect the information for analysis. This study looked at children with focal epilepsy (two or more unprovoked seizures) who had convulsive SE (> 30 minutes of unconsciousness with continuous or repeated seizures) at any time in their lives. In addition to requiring adequate follow-up, the study criteria required normal intelligence (IQ > 70) and no neurological deficits interfering with daily activities. Because of the era of diagnosis, MRI data was not included, but CT was available in 86%; approximately 60% of patients had no identifiable cause for epilepsy. The selection conditions, therefore, must eliminate some cases of remote symptomatic epilepsy, a subgroup with a higher risk of SE (5). It would not be surprising if patients with baseline cognitive impairment and other neurological disability would have different SE outcomes than those of neurologically normal patients in the current study. This study looked at the consequences of SE, particularly evidence for brain injury or worsening of subsequent seizure control. The measure of brain injury addressed was cogni-tive function. …