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Status epilepticus

Prevalence
Causes
Clinical features
Investigations
Therapy
Prognosis
Clinical features

Look for a cause d

Ask about

  • previous fits
  • trauma
  • medication
  • alcohol and street drugs
Look for
  • focal neurological signs
  • signs of infection
  • drug misuse
Exclude
  • hypoxia
  • hypoglycaemia
Think about status in patients in a coma. Signs can be subtle. Look for twitching of extremities, mouth and eyes, but these may be absent.

Watch out for pseudoseizures. 

These are more likely if c  

  • there is no clear cause for fitting
  • the patient has a psychiatric history
  • the patient is conscious yet having seizures with bilateral motor activity
  • attacks seem atypical
  • the patient resists examination
  • the patient calls out
These are less likely if patients have extensor plantar during seizures c  

If in doubt, treat the patient for status epilepticus, but seek expert help d, and watch for medication side-effects.


Expiry date: September 2004
Levels of Evidence used in grading these guides

Author   RS   Phillips, CM   Ball
Reviewer   S   Straus
CAT Writer   RS   Phillips, C   Wotton, CM   Ball