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
Treatment algorithm
Contributors
Authors
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).
Assistant Professor of Neurology
Johns Hopkins Medical Institutions
Baltimore
MD
Disclosures
EJ declares that she has no competing interests.
Dr Ronald P. Lesser and Dr Emily Johnson would like to gratefully acknowledge Dr Mohammad Koubeissi and Dr Nabil Azar, previous contributors to this topic.
Peer reviewers
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.
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