Diagnosis

Diagnosis of generalized convulsive status epilepticus is usually straightforward with the patient presenting with generalized tonic or clonic activity (1)

The following investigations should be carried out as soon as possible and should accompany pharmacological interventions simultaneously (2).

• in all patients
  • fingerstick glucose (BM)
  • monitor vital signs
  • computed tomography (CT) scan (appropriate for most cases) of the head- once the patients is stabilised
  • laboratory studies:
    • blood glucose
    • complete blood count
    • basic metabolic panel e.g. - serum electrolytes, blood urea nitrogen (BUN), creatinine,
    • calcium (total and ionized)
    • magnesium
    • AED levels
  • continuous electroencephalograph (EEG) monitoring
    
    
• according to the clinical presentation (patient's history and events leading up to presentation)
  • brain MRI
  • lumbar puncture - in suspected cases of CNS infection or subarachnoid hemorrhage
  • comprehensive toxicology screen to identify toxins which may be responsible for seizures e.g - isoniazid, tricyclic antidepressants, theophylline cocaine, sympathomimetics, alcohol, organophosphates, and cyclosporine
  • other laboratory tests e.g. - liver function tests,

Reference:

• (1) Rabinstein AA. Management of status epilepticus in adults. Neurol Clin. 2010;28(4):853-62
• (2) Brophy GM et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17(1):3-23.
• (3) Shearer P, Riviello J.Generalized convulsive status epilepticus in adults and children: treatment guidelines and protocols. Emerg Med Clin North Am. 2011;29(1):51-64.