How is status epilepticus (SE) diagnosed?

Updated: Feb 13, 2018
  • Author: Julie L Roth, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Examination for status epilepticus includes the following:

  • Generalized convulsive status epilepticus: Typical rhythmic tonic-clonic activity, impaired consciousness; rarely, may present as persistent tonic seizure

  • Status epilepticus due to the use of illicit, or street, drugs: needle-track marks

  • Status epilepticus due to possible mass lesion or brain infection: Papilledema, lateralized neurologic features

  • Subtle or transformed status epilepticus: Any patient without improving level of consciousness within 20–30 minutes of cessation of generalized seizure activity; ocular and fine motor findings such as nystagmus, pupillary hippus, or myoclonic or clonic movements of a hand, foot, digit or face.

  • Associated injuries in patients with seizures: May include tongue lacerations (typically lateral), shoulder dislocations, head trauma, facial trauma

Classification

The Luders and Rona semiologic classification consists of 3 axes, as follows [1] :

  • The type of brain function predominantly compromised

  • The body part involved

  • The evolution over time

The Treiman classification is as follows:

  • Generalized convulsive status epilepticus

  • Subtle status epilepticus

  • Nonconvulsive status epilepticus (eg, absence, complex partial)

  • Simple partial status epilepticus

The International League Against Epilepsy (ILAE) classification [2] consists of 4 axes, as follows:

  • Semiology - including those with or without prominent motor findings
  • Etiology - known and unknown causes
  • EEG correlates - description of the EEG
  • Age - neonatal, infancy, childhood, adolescent, adult, and elderly

Testing

The workup for potential status epilepticus is similar to that for any self-limited seizure but is done more expeditiously to confirm the diagnosis and to abort or limit the seizures.

Stat laboratory studies that should be obtained include the following:

  • Glucose and electrolyte levels (including calcium, magnesium)

  • Complete blood count

  • Renal and liver function tests

  • Toxicologic screening and anticonvulsant drug levels

  • Arterial blood gas results

Other tests that may be appropriate depending on the clinical setting include the following:

  • Electroencephalography: Criterion standard for diagnosing status epilepticus [3, 4] ; however, neurologic consultation is usually required

  • Blood cultures

  • Urinalysis and/or cerebrospinal fluid analysis

Imaging studies

Imaging modalities used to evaluate status epilepticus may include the following:

  • CT scanning and/or MRI of the brain

  • Chest radiography for etiology

Procedures

If a central nervous system infection is suspected, consider performing a lumbar puncture (after neuroimaging to rule out potential cerebral herniation).

See Workup for more detail.


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