Diagnosis of generalized convulsive status epilepticus is usually straightforward with the patient presenting with generalized tonic or clonic activity. (1) Convulsive status epilepticus is a medical emergency that needs immediate treatment with anticonvulsant therapy.
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 haemorrhage
- 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
- Epilepsies in children, young people and adults; NICE guidance (2022 - last updated January 2025)
- Brophy GM, Bell R, Claassen J, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012 Aug;17(1):3-23