Seizures are temporary phenomena; some individuals have got repeated episodes of seizures. These repeated episodes have been given a medical name of epilepsy. Individuals with seizures may present in different ways depending upon the level of and number of neurons involved. In a number of individuals, it is just a jerky movement involving one or more limbs or other areas with conscious level maintained while in others the movements may involve whole body and individual may loose her/his consciousness. So, seizures have been classified according to the level of complexity and consciousness. When some parts of the body are involved, seizures are called as partial otherwise they are generalized. If consciousness is lost which usually occurs with generalized seizures then these are called complex, if consciousness is present, these are simple seizures. Generalized seizures may affect body in a variety of ways and they have been further divided based on the types of movements they are producing: absence, myoclonic, clonic and atonic seizures. In contrast, there are some situations in which these seizures may be single, for example: trauma or head injury, high grade fever especially in children, a symptom of other diseases including tumor and reactions to some drugs. At times, a partial seizure may spread in the brain when it is called secondary generalization.
A persistent state of seizures for more than 5 minutes or by other doctors for 30 minutes is called status epilepticus. It is a real emergency state, which needs urgent measures to bring the patient out of the condition (Wikipedia, Carpenter ch:125).
Treatment is required when seizures become recurrent. If the cause of the seizure is removed then there is no need of use of epileptic drugs; this occurs in situations like febrile conditions in children or seizures due to electrolytes imbalance. Main purpose of these drugs is to stop seizures because in addition to the direct effects of seizures there are chances of more severe complications, for example accidents resulting from seizures while driving, to arise if these seizures are not treated effectively. The criteria for starting anti-epileptic drugs are: evidence of focal neurological lesion based on clinical examination, radiological findings or EEG interpretations. If seizures occur once and there are no other findings especially in adults then there is no need of epileptic drugs. These drugs have been classified and prioritised for various types of seizures:
Partial - simple and complex: carbamazepin,phenytoin, valproate, gabapentin,
Secondary generalized: carbamazepin, phenytoin, valproate, gabapentin, lamotrigine,
Primary Generalized - absence: ethosuximide, valproate, lamotrigine
Primary Generalized - tonic-clonic: valproate, carbamazepin, phenytoin, lamotrigine
Primary Generalized - myoclonic and tonic: valproate, clonazepam
Some of the patients do not get benefits from the medical treatment. The only option left for them is surgical resection of the hyperactive area in the brain. This is a very sophisticated procedure, which requires exact location of the area of brain with abnormal hyper excitability (Carpenter ch:125).
Treatment of choice for status epilepticus has been diazepam even in the presence