Tiny Tips: Seizures and STATUS EPILEPsy

In Tiny Tips by Teresa Chan1 Comment

Seizure is a common presenting complaint in the Emergency Department.  According to one study seizure related presentations amount to about 1% of all ED visits.

In that same study, status epilepticus accounted for around 6% of those patients presenting with seizures  And that was in 2000. Since then, then the definition of status epilepticus has changed.  In 2008, the Neurocritical Care Society introduced a new definition for Status Epilepticus.

Status Epilepticus is now defined as:

5 minutes or more of (i) continuous clinical and/or electrographic seizure activity or (ii) recurrent seizure activity without recovery (returning to baseline) between seizures.” (Brophy, et al., 2012)

The impetus for this is more clearly delineated in their paper, but suffice it to say, they changed it because…
a) By 5 minutes a seizure is like the Energizer Bunny: it keeps going and going… and is unlikely to stop.
b) The brain is frying: 30 minutes (the old definition) was too long because neuronal injury/pharmacoresistance likely occurs WAYYYY before 30 min of continuous seizing.

While there is still SOME controversy on this topic, most people have bought in.  Especially Emergency Physicians.  Have you ever tried to keep an ER Doc from a seizing patient for more than 30 seconds, let alone 5 minutes??

The Mnemonic:  STATUS EPILEPsy

During the Year-That-Shall-Not-Be-Named (my exam year), I tried really hard to create mnemonics that actually RELATED to the topic.  This helps with building neuronal connections

MedEd NERD Moment #1:  Constructivist and Connectivism theories suggest that new information based on or connected to prior knowledge is more easily learned.

That said, when you have about 200 mnemonics, your memory may also fail you.  One way of combating that is to continually review the mnemonics.  Reviewing either on flash cards or by quizzing (verbal or written) has a great effect on learning as well.
MedEd NERD Moment #2:  For more insight into retrieval practice, check out Javier Benitez’s post to the ALiEM website!
Flash card versions of all of the Boring Cards are available through Flashcard Exchange. Instructions are available here.
Onto the mnemonic!


S alicylates / Seizure med noncompliance
T ricyclic Antidepressants
A VM / Acute hydrocephalus / Anticholinergics
T rauma / Traumatic bleed (ICH, SDH)
U remia (Renal Failure)
S trychnine

E lectrolytes (Hyponatremia, Hypocalcemia)
P esticides
I ctogenic foci (e.g. post TBI, post stroke)
L ithium / Lidocaine intoxication / Low BG
E clampsia / EtOH withdrawal
Psy-chogenic Non-Epileptic Seizures (formerly known as ‘pseudo seizures’)

This post was written by Teresa Chan and reviewed by Brent Thoma

Teresa Chan

Senior Editor at CanadiEM
Emergency Physician. Medical Educator. #FOAMed Supporter, Producer and Researcher. Chief Strategy Officer of CanadiEM. Associate Professor, Division of Emergency Medicine, Department of Medicine, McMaster University.