Status epilepticus

Last reviewed: 21 Apr 2022
Last updated: 16 Oct 2020

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)
More key diagnostic factors

Other diagnostic factors

  • prolonged focal motor activity, or sensory or autonomic symptoms with intact consciousness (focal aware SE)
  • low oxygen saturation
Other diagnostic factors

Risk factors

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

Diagnostic investigations

1st investigations to order

  • anticonvulsant drug blood level
  • toxicology screen
  • comprehensive metabolic panel
  • CBC
  • ECG
  • electroencephalography (EEG)
More 1st investigations to order

Investigations to consider

  • ABG
  • CT head
  • lumbar puncture
  • MRI head
More investigations to consider

Treatment algorithm

ACUTE

generalized convulsive status epilepticus

nonconvulsive status epilepticus

focal aware (simple partial) status epilepticus

Contributors

Authors

Emily L. Johnson, MD

Assistant Professor of Neurology

Johns Hopkins Medical Institutions

Baltimore

MD

Disclosures

ELJ has been reimbursed by New England Journal of Medicine Knowledge+ and Univadis MD for developing educational materials.

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. NJA declares that he has no competing interests. MZK declares that he has no competing interests.

Peer reviewers

Yvonne Hart, MBBS

Consultant Neurologist

John Radcliffe Hospital

Oxford

UK

Disclosures

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.

  • Differentials

    • Psychogenic nonepileptic SE
    • Delirium
    • Coma
    More Differentials
  • Guidelines

    • Evidence-based guideline: treatment of convulsive status epilepticus in children and adults
    • EFNS guideline on the management of status epilepticus in adults
    More Guidelines
  • Patient leaflets

    Epilepsy: what is it?

    Epilepsy: what treatments work?

    More Patient leaflets
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