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Symptoms & Signs

• Generalized SE
  • Overt convulsions
  • After 30–45 minutes of uninterrupted seizures, signs may become increasingly subtle.
    • Mild clonic movements of only the fingers
    • Fine, rapid movements of the eyes
    • Paroxysmal episodes of tachycardia, hypertension, and pupillary dilation
  • Patients who remain unresponsive following termination of overt convulsions may remain in nonconvulsive SE, a condition often detectable only by electroencephalogram (EEG).

Differential Diagnosis

• Coma
  • After overt seizures, if patient remains comatose, EEG should be obtained to evaluate for ongoing nonconvulsive SE.
• Nonepileptic SE
  • May occur in patient with psychogenic nonepileptic seizures

Diagnostic Approach

• SE is a medical emergency.
• Patients must be evaluated promptly and appropriate therapy instituted without delay.
• Treatment of ongoing seizures must occur in parallel with an investigation of the cause of the seizures in order to prevent recurrence and treat any underlying abnormalities.
• The patient who remains comatose following termination of overt seizures should have an EEG to evaluate for ongoing nonconvulsive SE.

Laboratory Tests

• Laboratory studies to consider:
  • Anticonvulsant levels
  • Complete blood count with differential
  • Serum electrolytes including calcium, magnesium, and phosphate
  • Creatinine and blood urea nitrogen
  • Glucose
  • Creatine phosphokinase
  • Serum osmolality
  • Liver and renal function tests
  • Toxicology tests: blood and urine
  • Arterial blood gas
  • Carboxyhemoglobin

Imaging

• CT or MRI of brain
  • If indicated to determine cause of SE
  • Obtained as soon as possible once seizures have been controlled and patient is medically stable

Diagnostic Procedures

• EEG
  • Evaluate with EEG as soon as possible.
  • If overt seizures stop, but patient remains comatose, perform EEG to exclude ongoing SE.

The Harrison's Practice Preview allows you to view 5 FREE complete topics or conduct a search that delivers abstracts for more than 450 medical topics. For full access, please subscribe today!