Last reviewed: November 2017
Last updated: November  2017



History and exam

Key diagnostic factors

  • persistent or repetitive tonic-clonic seizures with altered level of consciousness (generalized convulsive SE)
  • altered awareness/confusion (nonconvulsive SE)

Other diagnostic factors

  • prolonged focal motor activity, or sensory or autonomic symptoms with intact consciousness (simple partial SE)
  • low oxygen saturation

Risk factors

  • nonadherence to anticonvulsant drugs
  • chronic alcoholism
  • refractory epilepsy
  • toxic or metabolic causes
  • processes leading to direct cortical structural damage
  • drug use

Diagnostic investigations

1st investigations to order

  • anticonvulsant drug blood level
  • toxicology screen
  • comprehensive metabolic panel
  • CBC
  • ECG
Full details

Investigations to consider

  • EEG
  • ABG
  • CT head
  • lumbar puncture
  • MRI head
Full details

Treatment algorithm


Authors VIEW ALL

Associate Professor of Neurology

Division of Epilepsy

Vanderbilt University Medical Center




NJA declares that he has no competing interests.

Dr Nabil J. Azar would like to gratefully acknowledge Dr Mohammad Z. Koubeissi, the previous contributor to this monograph. MZK declares that he has no competing interests.

Peer reviewers VIEW ALL

Professor of Neurology and Neurosurgery

Johns Hopkins Medical Institutions




RPL's wife has shares in Abbott Laboratories, which makes Depakote, a brand formulation of valproate.

Consultant Neurologist

John Radcliffe Hospital




YH has been reimbursed by UCB Pharma Ltd, Janssen-Cilag Ltd, Pfizer Ltd, and Eisai Ltd for attending conferences; has taught at meetings sponsored by the above companies and by GlaxoSmithKline Services Unlimited; and has received payment for advisory board work from UCB Pharma Ltd, Janssen-Cilag Ltd, Eisai Ltd, and GlaxoSmithKline Services Unlimited.

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