Diagnosis of Status Epilepticus

In this article, we will discuss the Diagnosis of Status Epilepticus. So, let’s get started.

Diagnosis

Diagnosis of overt tonic-clonic status epilepticus is not difficult when two or more convulsions occur consecutively without regaining of consciousness between seizures in the absence of intake of benzodiazepines. However, after 30 to 45 minutes of uninterrupted seizures, the signs may become subtle. Patient may have mild chronic jerks of only fingers, or fine, rapid movement of eyes. There may be paroxysmal episodes of tachycardia, hypertension pupillary dilatation. In such cases, EEG is the only method to establish the diagnosis. Thus, if the patient stops having overt seizures, yet remains comatosed, an EEG should be performed to rule out ongoing status epilepticus.

The diagnosis of nonconvulsive status epilepticus is often difficult because partial depression of consciousness or abnormal behaviour or confusion may mimic a psychiatric disorder. The diagnosis is confirmed by demonstration of ictal activity on EEG, therefore EEG is also helps to differentiate nonconvulsive status epilepticus from hysterical behaviour or a psychiatric disorder.

Investigations

The EEG: All cases of status epilepticus should ideal be managed using simultaneous recording of EEG. It is also essential for diagnosis of status when convulsive movement have stopped and the patient has not recovered consciousness or when patient having a single convulsion fails to regain consciousness. It is actually indispensable investigation for nonconvulsive status.

Biochemical profile, e.g. blood urea, blood sugar, serum creatinine, liver function tests, serum electrolytes, calcium ions and phosphorus to find out any metabolic cause of epilepsy.

Complete blood count (TLC and DLC). C-reactive protein, chest X-ray for evidence of any infection or aspiration.

Toxicological screening of blood and urine samples.

Antiepileptic drug levels.

CT and MRI scan: These imaging techniques help to find out the cause. These are done to find out any structural lesions. Most clinicians routinely order MRI (if not contraindicated) in all patients with new onset of seizure what to talk of status epilepticus. It is done as soon as seizures are under control. Indications for imaging are:

  • Epilepsy starts after the age of 20
  • Focal seizures
  • Abnormal EEG with focal seizure source
  • Refractory or resistant seizures

Lumbar puncture: It is indicated when either and ineffective cerebral or meningeal disease is being suspected and there is no evidence of raised intracranial pressure or CT/MRI scans are noncontributory towards its cause. The CSF should be sent for biochemistry cytology and culture.

Serology for syphilis, HIV, collagen vascular disease.

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