Clinical Assessment and Risk Stratification

There are numerous forms of SE, and classification is important to help direct the appropriate level of treatment and investigation.

Broadly speaking, SE may be categorised as being either:

• Convulsive

• Non-convulsive

The classification depends on the presence, or absence, of regular focal or generalised contractions of the muscles.

Convulsive status may be further classified as:

• Generalised (involving the entire brain)

• Partial (involving only part of the brain) [7]

However, other forms exist but these relate to less common presentations:

• Absence

• Myoclonus, or pseudo-status epilepticus, which is characterised by tonic-clonic jerks in the absence of true altered consciousness

Generalised tonic-clonic SE

Generalised tonic-clonic SE is the most clinically obvious presentation of SE.

It begins with a sudden powerful contraction of the muscles (tonic phase) often associated with a fall to the floor, followed by regular rhythmic contraction and relaxation (clonic phase) of the musculature of all limbs.

This is invariably associated with alterations in the level of consciousness.

Partial SE

Partial SE is defined by seizures originating from a specific area of the cortex without any impairment of consciousness.

Presentation may be far more subtle than for generalised seizures and may involve:

• Motor symptoms (e.g. regular rhythmic contractions of a single limb or muscle group)

• Sensory symptoms (e.g. illusions, hallucinations and depersonalisation)

Complex partial seizures are associated with a degree of conscious impairment and arise from a single region of the brain. Symptoms may include:

• Aphasia
• Apraxia
• Focal limb weakness

Complex partial seizures may often be associated with motor or verbal automatisms.