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Status Epilepticus

What is status epilepticus?

A seizure involves abnormal electrical activity in the brain affecting both the mind and the body. Many problems can cause you to have a seizure. These include high fever, brain infections, abnormal sodium or blood sugar levels, or head injuries. If you have epilepsy, you may have seizures repeatedly.

A seizure that lasts at least 30 minutes is called status epilepticus, or a prolonged seizure. This is a medical emergency that may lead to permanent brain damage or death. Many medical experts become concerned that a seizure is status epilepticus after it lasts 5 to 10 minutes.

Status epilepticus is very rare, most people with epilepsy will never have it. This condition is more common in young children and elderly adults.

This condition can occur as:

  • Convulsive status epilepticus. Status epilepticus with convulsions may be more likely to lead to long-term injury. Convulsions may involve jerking motions, grunting sounds, drooling, and rapid eye movements.
  • Nonconvulsive status epilepticus. People with this type may appear confused or look like they're daydreaming. They may be unable to speak and may be behaving in an irrational way.

What causes status epilepticus?

In children, the main cause of status epilepticus is an infection with a fever. In adults, the common causes include:

  • Stroke
  • Imbalance of substances in the blood, such as low blood sugar

  • Drinking too much alcohol or having alcohol withdrawal after previous heavy alcohol use

Who is at risk for status epilepticus?

There are many risk factors for status epilepticus including:

  • Poorly controlled epilepsy
  • Low blood sugar
  • Stroke
  • Kidney failure
  • Liver failure
  • Encephalitis (swelling or inflammation of the brain)
  • HIV
  • Alcohol or drug abuse
  • Genetic diseases such as Fragile X syndrome and Angelman syndrome
  • Head injuries

What are the symptoms of status epilepticus?

These are possible symptoms of status epilepticus:

  • A seizure that lasts more than 5 minutes, or more than one seizure in a row without regaining consciousness in between
  • Muscle spasms
  • Falling
  • Confusion
  • Unusual noises
  • Loss of bowel or bladder control
  • Clenched teeth
  • Irregular breathing
  • Unusual behavior
  • Difficulty speaking
  • A "daydreaming" look

How is status epilepticus diagnosed?

Your health care provider will do a thorough physical exam and ask about your health history, any medications you are taking and if you’ve been using alcohol or other recreational drugs.

Your health care provider may also order an electroencephalogram. This involves placing painless electrodes onto your scalp to measure the brain's electrical activity.

You may need other tests to search for possible causes. These include a lumbar puncture -- or spinal tap -- to look for signs of infection. A CT scan or MRI may be needed to see problems in the brain.


How is status epilepticus treated?

The health care provider will want to end the seizure as quickly as possible and treat any underlying problems that are causing it. You may receive oxygen, have blood tests, and an intravenous (IV) line. You may be given glucose (sugar) if low blood sugar may be causing the seizure.

Health care providers may use anti-seizure drugs to treat the problem, including:

  • Diazepam
  • Lorazepam
  • Phenytoin
  • Fosphenytoin
  • Phenobarbital
  • Valproate

These drugs are given through an IV or an injection into a muscle.

What are the complications of status epilepticus?

Complications depend on the underlying cause and can range from none to death. If the underlying cause, such as poor epilepsy control, can be fixed, there may no complications. If the underlying cause is a stroke or brain injury, complications may include physical disability from the cause or even death.

Can status epilepticus be prevented?

If you have epilepsy, taking your medications as directed may help you avoid status epilepticus. If you’ve had status epilepticus, you may need to begin taking seizure medicines or change medications you’re already taking. Avoiding other causes of this condition, such as alcohol abuse or low blood sugar, may also help prevent it.

Key points

  • Status epilepticus has many causes. Some can be prevented such as low blood glucose or alcohol and drug abuse.
  • Individuals who have epilepsy must take their medication as directed
  • A seizure that lasts more than 5 minutes or more than one in a row is an emergency that requires immediate medical care

Next steps

Tips to help you get the most from a visit to your health care provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.
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