Estado de mal epiléptico
Summary
Definition
History and exam
Key diagnostic factors
- convulsões tônico-clônicas persistentes ou repetitivas com nível de consciência alterado (estado de mal epiléptico convulsivo generalizado)
- alteração do nível de consciência/confusão (estado de mal epiléptico não convulsivo)
Other diagnostic factors
- estado de mal epiléptico focal sem alteração da consciência
- baixa saturação de oxigênio
Risk factors
- não adesão aos anticonvulsivantes
- transtornos decorrentes do uso de bebidas alcoólicas
- acidente vascular cerebral (AVC)
- epilepsia refratária
- causas tóxicas ou metabólicas
- processos que causam a lesão direta da estrutura cortical
- uso de determinados medicamentos
Diagnostic investigations
1st investigations to order
- nível de anticonvulsivante no sangue
- análise toxicológica
- perfil metabólico completo
- Hemograma completo
- eletrocardiograma (ECG)
- eletroencefalografia (EEG)
Investigations to consider
- gasometria arterial
- tomografia computadorizada (TC) do crânio
- punção lombar
- ressonância nuclear magnética (RNM) de crânio
- EEG contínuo (EEGc)
Treatment algorithm
estado de mal epiléptico convulsivo generalizado
estado de mal epiléptico não convulsivo
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 healthcare products: Abbott Labs, Apple, Avanos, Celgene, Express Scripts, Johnson and Johnson, and Pfizer. MK declares that he has no competing interests. NA 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
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.
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.
References
Key articles
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. Abstract
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.Full text Abstract
National Institute for Health and Care Excellence. Epilepsies in children, young people and adults. Jan 2025 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Estado de mal epiléptico (EME) não epilético
- Delirium
- Coma
More DifferentialsGuidelines
- Epilepsies in children, young people and adults
- Emergency management of the paediatric patient with convulsive status epilepticus
More GuidelinesPatient information
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