History and exam

Key diagnostic factors

common

prolonged tonic-clonic seizures with an altered level of consciousness (convulsive SE)

Prolonged (longer than 5 minutes) tonic-clonic seizures involving stiffening of the whole body (tonic phase) followed by vigorous shaking (clonic phase).[17]

The patient will typically have their eyes open and be unresponsive to commands or sensory stimuli.[18]​[21]​​

altered level of consciousness, confusion or change in personality with limited or absent motor findings (non-convulsive SE)

Non-convulsive status epilepticus may present as:[20]

  • Prolonged change in personality, prolonged post-ictal confusion (greater than 20 minutes), or recent-onset psychosis in a patient with a previous diagnosis of epilepsy

  • Confusion or personality change (typically seen in the setting of a metabolic derangement, encephalitis, or other acute precipitant) in a non-comatose patient with no history of epilepsy.

Be aware that non-convulsive status epilepticus can follow convulsive status epilepticus. Refer the patient to the neurology team for specialist clinical assessment (recommendation based on clinical experience).

risk factors

Consider key risk factors for status epilepticus:

  • Poor anticonvulsant therapy adherence in people with known epilepsy[9]

  • Alcohol-use disorder; alcohol withdrawal[1][11][14]

  • Toxic or metabolic causes such as disturbances in water, glucose, and electrolyte metabolism[1][11]

  • Processes leading to cortical structural damage such as hypoxic-ischaemic brain injury, head trauma, stroke (ischaemic, haemorrhagic), subarachnoid haemorrhage, tumours, or brain infections (abscess, meningitis, encephalitis)[9][11]

  • Use of recreational or restricted drugs (e.g., cocaine, amphetamines).[21]

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