Status epilepticus (peds)
Background
For a child over 1 month of age
- Categorized as convulsive or non-convulsive
- Convulsive status epilepticus: patient will have tonic-clonic movements with altered mental status, may have focal neuro deficits post-ictally (Todd's paralysis)
- Non-convulsive status epilepticus: patient will have seizure activity on EEG without clinical findings
Clinical Features
- Defined as: an unresponsive patient with either one of the following
- Seizure >5 min and/or ongoing seizure on presentation
- 2 or more seizures without full recovery of consciousness between seizures
Differential Diagnosis
- Fever, severe infection (meningitis, encephalitis)
- Anoxic injury
- Electrolyte derangements
- Hyper or hypoglycemia
- Hyper or hyponatremia
- Hyper or hypocalcemia
- Traumatic brain injury (TBI)
- Anti-epileptic drug (AED) non-adherence, overdose, withdrawal
- Toxic exposure
- Structural abnormality of the brain
- Hypoxic-ischemic encephalopathy (HIE)
- Neurodegenerative disorder
- Stroke
- Genetic condition
Evaluation
Workup
- Check a blood glucose
- Consider an electrolyte panel, a blood gas, CBC, calcium level, LFTs
- If appropriate collect anticonvulsant drug levels
- Consider blood & urine culture
- Data for lumbar puncture routinely is not conclusive - consider it in a febrile patient with signs of meningitis or localized neuro findings (perform once patient is stabilized)
- Consider toxicology studies
- Consider EKG to evaluate for arrhythmias, toxins and electrolyte abnormalities
- May consider head imaging once patient is stabilized
Diagnosis
Management
- ABC's
- Provide O2 via non-rebreather mask, 10-15 L/min
- Give benzodiazepines as early as possible
- Monitor for respiratory depression
- Give acetaminophen 15 mg/kg/dose (MAX 650 mg) if febrile
Disposition
- Criteria for admission
- Patients with refractory seizures
- Patients who are not responsive within 4-6 hours of arrival to the ED
- Criteria for discharge
- Patients who have returned to baseline post seizure management
- Patients whose parents/guardians feel comfortable with discharge and have been counseled about what to do if seizure recurs