Status epilepticus

In the third watch of the night, his eyes turned into brown and yellow. Hands and feet got cold; darkened he became. His mouth began to open and shut; his body lost stability.

As he stuck in between the state of lucid-interval; his body was fragile. It seemed like he saw a voracious monster. Yes, indeed he did. The bloodhound harried over and over again. It stalked him for a hand full of time, and now it sought his soul. Chances are so sleek for him to survive. Once he gives up, he ends up as a cadaver.

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History excelled in recording it thoroughly despite the beliefs. Lurking in the shadows it preyed: the evil. It’s merciless and didn’t spare a soul. So awful it is, besieged children time and time again and continued to do so. Sakikku – A prominent Neo-Babylonian manuscript compiled circa 1000 BC is held in the British Museum, London. The tablet 26th of the Sakikku cuneiform records one such evil known as ‘Miqtu.’ “C’est ce que les, maladies appellent entre eux etat de mal.” It’s what the patients among themselves call Etat de mal epileptique translated as Status-epilepticus.

According to ILAE, SE is defined as seizures that last for more than 30minutes constituting medical emergency associated with irreversible neuronal damage. “Fits can recur… In the same day, and comments further on the mortality when the attack extends into the second day.” The incidence follows a parabolic distribution.

Up to 75 to 80% of the paediatric cases occurred before five years, and the infants are more susceptible to it. Records have shown that 25% of people who have status epilepticus have known to be diagnosed with epilepsy. This can occur without any history of epilepsy. Aetiology includes epilepsy, neurological and medical illness, ill-defined electrochemical syndrome, cerebrovascular diseases; adults-25%, paediatric- 3%. In India, the percentage of the factors involved are CNS infection, drugs, metabolic diseases, stroke and miscellaneous are reckoned to be 53.8%, 7.9%, 14.5%, 12.8%, and 11%, respectively.

The World Health organisation logs that 80% of people with epilepsy happened to dwell in low and middle-income countries. If epilepsy is ignored, it leads to a more significant treatment gap. Cultural beliefs, stigma, poor health infrastructure and a shortage of trained professionals, and especially poverty plays a prominent role. Proper knowledge of anti-epileptic drugs is crucial. The economic status of the country is essential to issue good medical care along with the awareness for its people to eradicate cultural beliefs.

The parallel findings in clinical studies have shown that the duration of SE allies with laissez-faire quantum of morbidity and mortality due to rhabdomyolysis, myocardial injury, respiratory failure. This happened to be way parlous than multiple sclerosis, cerebral palsy, muscular dystrophy and Parkinson’s disease. Prompt treatment and early diagnosis are beneficial.

Most of the seizures have a good prognosis when adequately treated, but in the case of SE, it becomes merely impossible and adamantly the question of ‘why’ is still in the active areas of enquiry.

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