Physicians are taught that a seizure lasting more than thirty minutes can do permanent damage to the brain. The medical literature says that as many as half of the patients with status epilepticus die or are left with

permanent brain damage. But sometimes the things we think we know are not true!

Recent evidence suggests that it is not the seizures but the cause of the seizures that does the brain damage. Status epilepticus can be a consequence of infection of the brain, such as meningitis or encephalitis. It can be a consequence of head trauma, brain tumors, or other serious causes. When status epilepticus is “symptomatic”—due to something serious—usually it is the “something serious” that does damage to the brain and causes the status epilepticus. It is this symptomatic status that may result in death or permanent brain damage. Whether the seizures themselves cause further damage is much less clear.

Status epilepticus may occur as the first seizure a child experiences and in that case is often the only seizure he ever has. Whether the patient’s first seizure is status or a brief, generalized, tonic-clonic seizure, most children (70 percent) never have another episode. Although there are many different causes of status epilepticus, in most children the cause remains unknown. When status epilepticus is of unknown cause or is part of a seizure disorder, it rarely causes permanent brain damage.

There are many causes of status epilepticus; whatever the cause, it is important to stop the prolonged seizures as promptly as possible. It is also crucial to evaluate each child and each episode of status to identify any underlying cause that may require specific treatment.

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