Summary
Definition
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
- focal SE without impaired consciousness
- low oxygen saturation
Risk factors
- nonadherence to anticonvulsant drugs
- alcohol-use disorder
- stroke
- 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
- electroencephalography (EEG)
Investigations to consider
- ABG
- CT head
- lumbar puncture
- MRI head
- continuous EEG (cEEG)
Treatment algorithm
generalized convulsive status epilepticus
nonconvulsive status epilepticus
focal without impaired consciousness
Contributors
Authors
Emily L. Johnson, MD
Associate Professor of Neurology
Johns Hopkins Medical Institutions
Baltimore
MD
Disclosures
ELJ declares that she has no competing interests.
Acknowledgements
Dr Emily L. Johnson would like to gratefully acknowledge Dr Ronald P. Lesser, Dr Mohammad Koubeissi, and Dr Nabil Azar, previous contributors to this topic.
Disclosures
RPL or his wife have stock in the following companies, which sell health care products: Abbott Labs, Apple, Avanos, Celgene, Express Scripts, Johnson and Johnson, and Pfizer. NA declares that he has no competing interests. MK declares that he has no competing interests.
Peer reviewers
Maria Jose Bruzzone Giraldez, MD
Assistant Professor Epilepsy Division
University of Florida
Gainesville
FL
Disclosures
None
Yvonne Hart, MBBS
Consultant Neurologist
John Radcliffe Hospital
Oxford
UK
Divulgaciones
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referencias
Artículos principales
Brophy GM, Bell R, Claassen J, et al; Neurocritical Care Society Status Epilepticus Guideline Writing Committee. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012 Aug;17(1):3-23. Resumen
Glauser T, Shinnar S, Gloss D. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016 Jan-Feb;16(1):48-61.Texto completo Resumen
National Institute for Health and Care Excellence (UK). Epilepsies in children, young people and adults. Apr 2022 [internet publication].Texto completo
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Nonepileptic SE
- Delirium
- Coma
Más DiferencialesGuías de práctica clínica
- Emergency management of the pediatric patient with convulsive status epilepticus
- Evidence-based guideline: treatment of convulsive status epilepticus in children and adults
Más Guías de práctica clínicaFolletos para el paciente
Epilepsy: what is it?
Epilepsy: what are the treatment options?
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