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
- prolonged focal motor activity, or sensory or autonomic symptoms with intact consciousness (focal aware 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
- electroencephalography (EEG)
Investigations to consider
- ABG
- CT head
- lumbar puncture
- MRI head
Treatment algorithm
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 DifferentialsGuidelines
- Evidence-based guideline: treatment of convulsive status epilepticus in children and adults
- EFNS guideline on the management of status epilepticus in adults
More GuidelinesPatient leaflets
Epilepsy: what is it?
Epilepsy: what treatments work?
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