Evidence-based On-call

Coma

Immediate management

Look for status epilepticus ^c

.

Signs can be subtle. Look for twitching of extremities, mouth and eyes, but these may be absent.

Why?

Patients in a coma who have rhythmic clonic movements are at increased risk of having status epilepticus. ^a
Patients in a coma may display no clinical signs of status epilepticus, but still have it. ^a
A fifth of patients with status epilepticus may not be convulsing. ^c