How are SPSE and EPC diagnosed?

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

In patients with preserved consciousness and sensory or motor symptoms compatible with focal SE, a history of epilepsy may help focus the workup tremendously. In particular, if seizures in SE are the same as previous focal seizures, the patient is not apt to have a newly acquired CNS lesion.

Instead, the SE episode may reflect subtherapeutic anticonvulsant levels, new toxic or metabolic derangements, intercurrent infection (usually outside of the CNS), recent stress, or sleep deprivation, as in any breakthrough seizure in a patient with known epilepsy. In some situations, no new precipitant can be found, though one should be sought aggressively.

In patients without a previous diagnosis of epilepsy, an aggressive search for a new or preexistent focal CNS lesion is paramount. Because patients with established epilepsy are not immune to new CNS lesions, a search for a new CNS process should be considered if their established epileptic focus does not seem to account for the ongoing SE.

Search for a new focal lesion early because certain acute processes pose high rates of morbidity and may require treatment independent of the SE. For example, quickly finding a new cardioembolic stroke due to atrial fibrillation is pivotal because this condition must be dealt with swiftly, in parallel with focal SE, if both apply.


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