Estado de mal convulsivo. Aspectos fisiopatológicos e clínicos.

Resumo

Convulsive status epilepticus (CSE) is a medical emergency with a prognosis associated to its duration, aetiology and patient age. On account of the absence of a satisfactory definition and of its clinical and electroencephalographical dynamic temporal evolution, recognition of this entity is a major clinical problem. Only the early recognition of CSE allows an urgent treatment, the reason why it should be adopted the following practical definition: 5 min or more of continuous seizures or two or more seizures without regain of consciousness between them. The treatment should be immediately initiated whenever a patient has a convulsion that persists more than 5 min, has a second seizure in the posictal period, or experience a generalized tonic-clonic convulsion at the time of arrival in the emergency department. The typical temporal evolution of CSE affects its prognosis since subtil SE is more refractory to treatment than evident SE. The monitoring of any kind of treatment protocol should have not only a careful clinical observation but also an EEG continuous record.