Status Epilepticus


Definition: > 30 min. of constant or repetitive seizing without recovery

  • 2 types of status epilepticus exist:
    1. Convulsive (clinical) – usually generalized tonic-clonic seizures. Has the highest morbidity (subsequent CNS deficits) & mortality
      1. A clinical diagnosis
    2. Non-convulsive (subclinical– either absence or partial-complex seizures. Highly undiagnosed; less morbidity & mortality
      1. May be difficult to clinically diagnose; seen on EEGs


Many different etiologies:

  • Infection (meningoencephalitis in all age groups)
  • Febrile seizure in otherwise healthy child
  • Progressive neurologic disease
  • Known epilepsy: sub-therapeutic drug levels, stress
  • Hypoxia
  • Metabolic disturbance: low dexi, Ca, Mg, Na; high uremia, IEMs
  • Structural disturbance: cyst, abscess, tumor
  • Toxins: EtOH ingestion/withdrawal, drugs
  • Vascular disturbance: old infarct, AVM, hemorrhage, stroke
  • Psych: pseudoseizures

Clinical Presentation

  • Depends on the variety of status epilepticus
    1. Convulsive SE presents with GTCs that last > 30 minutes or that repeatedly occur without resolution between seizures
    2. Non-convulsive SE may simply present as an extended staring spell or focal CNS deficit (e.g. arm twitch) that does not resolve



  1. Mitchell W.G. Status epilepticus and acute repetitive seizures in children, adolescents, and young adults: etiology, outcome, and treatment. Epilepsia 1996
  2. Sabo-Graham T. and Seay A. Management of Status Epilepticus in Children Pediatrics in Review September 1998
  3. Lowenstein D. Alldridge D. Current Concepts Status Epilepticus. NEJM April 1998
  4. Fenichel G.M. Clinical Pediatric Neurology, 4th edition. WB Saunders Co 2001.
  5. Riviello J.J. et al. Diagnostic Assessment of the Child with Status Epilepticus Neurolgy 2006
  6. Sofou K. et al. Management of Prolonged Seizures and Status Epilepticus in Childhood: A Systematic Review. Journal of Child Neurology. 2009