Status epilepticus

Last reviewed: 2 Sep 2023
Last updated: 16 Dec 2022



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

  • focal SE without impaired consciousness
  • low oxygen saturation
Other diagnostic factors

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
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
  • continuous EEG (cEEG)
More investigations to consider

Treatment algorithm


generalized convulsive status epilepticus

nonconvulsive status epilepticus

focal without impaired consciousness



Emily L. Johnson, MD

Assistant Professor of Neurology

Johns Hopkins Medical Institutions




ELJ declares that she has no competing interests.


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.


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

Yvonne Hart, MBBS

Consultant Neurologist

John Radcliffe Hospital




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

    • 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
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer