Last reviewed: 25 Oct 2020
Last updated: 13 Jul 2020

Summary

Definition

History and exam

Key diagnostic factors

  • prolonged or repeated tonic-clonic seizures with an altered level of consciousness (convulsive SE)
  • altered level of consciousness, confusion or change in personality with limited or absent motor findings (non-convulsive SE)
  • risk factors

Risk factors

  • poor anticonvulsant therapy adherence
  • alcohol-use disorder
  • stroke
  • toxic or metabolic causes
  • refractory epilepsy
  • processes leading to direct cortical structural damage
  • recreational drug use

Diagnostic investigations

1st investigations to order

  • glucose
  • arterial blood gases
  • urea
  • creatinine
  • liver function tests
  • sodium, calcium, and magnesium
  • full blood count
  • C-reactive protein
  • clotting screen
  • anticonvulsant drug levels
Full details

Investigations to consider

  • chest x-ray
  • CT-head
  • lumbar puncture 
  • toxicology screen
Full details

Treatment algorithm

Contributors

Expert advisersVIEW ALL

Consultant Neurologist

Greater Manchester Neurosciences Centre

Salford Royal Foundation Trust

UK 

Biography

MJ is an honorary senior lecturer at the University of Manchester.

Disclosures

MJ declares that he has no competing interests.

Neurology Registrar

Manchester Centre for Clinical Neurosciences

Salford Royal NHS Foundation Trust

UK

Disclosures

RP has been sponsored by Novartis to attend the International Headache Conference.

BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content:

Ronald P. Lesser, MD

Professor of Neurology and Neurosurgery

Johns Hopkins Medical Institutions

Baltimore

MD

Disclosures: RPL's wife holds shares in Abbott Laboratories, which makes Depakote, a brand formulation of valproate/divalproex. RPL holds shares in Abbvie, Express Scripts, Halgene, Halyard Health, Hospira, Johnson and Johnson (which makes Topamax, a brand formulation of topiramate), Merck and Company, and Pfizer (which makes Dilantin and Cerebyx, brand formulations of phenytoin and fosphenytoin, respectively).

*

Emily Johnson, MD

Assistant Professor of Neurology

Johns Hopkins Medical Institutions

Baltimore

MD

Disclosures: EJ declares that she has no competing interests.

Peer reviewersVIEW ALL

Professor of Epilepsy and Medical Education

Consultant Neurologist

St George's University Hospitals NHS Foundation Trust

London

UK

Disclosures

HC has received personal fees from Sage Pharmaceuticals Ltd, Eisai Europe Ltd, UCB Pharma Ltd, the European Medicines Agency, the UK Epilepsy Nurse Specialist Association, Bial, and Eisai. She has received non-financial support from Special Products Ltd, the European Academy of Neurology, and the International League Against Epilepsy E-learning Task Force. She has received grants from the US NIH Institute of Neurological Disorders and Stroke. HC also reports other conflicting interests related to Novartis and GW Research Ltd. HC is an author of a number of references cited in this topic.

Section Editor, BMJ Best Practice

Disclosures

HDC declares that she has no competing interests.

Lead Section Editor, BMJ Best Practice

Disclosures

SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including NICE, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, NCEPOD, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare, and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services. 

Lead Section Editor, BMJ Best Practice

Disclosures

TAO declares that she has no competing interests.

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

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