Pediatric Status Epilepticus Clinical Presentation

  • Author: Grace M Young, MD; Chief Editor: Richard G Bachur, MD   more...
 
Updated: Jan 24, 2011
 

History

In the initial presentation of status epilepticus, a directed history suffices. Obtain a more detailed history after stabilization, including the following details:

  • The course of current seizure activity - Time and nature of onset of seizure activity; involvement of extremities or other body parts; nature of movements (eg, eye movements, flexion, extension, stiffening of extremities), including any focal movements and details of postictal neurologic deficit; incontinence; cyanosis (perioral or facial); duration of seizure activity prior to medical attention; mental status after cessation of seizure activity
  • Fever or intercurrent illnesses
  • Prior history of seizures - If present, specify medications, anticonvulsant use, and compliance.
  • Head injury (recent and remote)
  • Central nervous system (CNS) infection or disease (eg, meningitis, neurocutaneous syndrome)
  • Intoxication or toxic exposure (see Causes for examples)
  • Other CNS abnormality (eg, ventricular-peritoneal shunt, prior CNS trauma)
  • Birth history and developmental delay (eg, anoxic encephalopathy, cerebral palsy)
  • Other medical history (eg, acquired immunodeficiency syndrome, systemic lupus erythematosus, type 1 diabetes mellitus)
Next

Physical

Perform a rapid, directed physical and neurologic examination during status epilepticus, followed by a detailed examination when the child is stabilized.

Signs of sepsis or meningitis include the following:

  • Temperature more than 38.5°C; in patients younger than 2-3 months, more than 38.0°C
  • Respiratory distress
  • Cyanosis
  • Poor peripheral perfusion
  • Bulging fontanelles in infant
  • Meningismus (in children >12-18 mo)
  • Presence of petechiae or purpura, herpetic vesicles

Evidence of head or other CNS injury includes the following:

  • Bradycardia, tachypnea, and hypertension (Cushing triad for signs of increased intracranial pressure)
  • Poor pupillary response
  • Asymmetry on neurologic examination
  • Abnormal posturing
  • Gross deformity or soft tissue injury to head

Hallmarks of neurocutaneous syndromes (eg, port wine stain) may be noted.

Previous
Next

Causes

Neonates (first month of life)

  • Birth injury (eg, anoxia, hemorrhage) and congenital abnormalities
  • Metabolic disorders (eg, hypoglycemia, hypocalcemia, hyponatremia) and inborn errors of metabolism (eg, lipidoses, amino acidurias)
  • Infection (eg, meningitis)

Early childhood (< 6 y)

  • Birth injury
  • Febrile convulsions (3 mo to 6 y)
  • Infection
  • Metabolic disorders
  • Trauma
  • Neurocutaneous syndromes
  • Cerebral degenerative diseases
  • Tumors
  • Idiopathic

Children and adolescents (>6 y)

  • Birth injury
  • Trauma
  • Infection
  • Epilepsy with inadequate drug levels
  • Cerebral degenerative disease
  • Tumor
  • Toxins
  • Idiopathic

Toxins and medications

  • Topical anesthetics (eg, lidocaine)
  • Anticonvulsant overdose
  • Camphor
  • Hypoglycemic agents (eg, insulin, ethanol)
  • Carbon monoxide
  • Cyanide
  • Heavy metals (eg, lead)
  • Pesticides (eg, organophosphate)
  • Cocaine
  • Phencyclidine
  • Belladonna alkaloids
  • Nicotine
  • Sympathomimetics (eg, amphetamines, phenylpropanolamine [recalled from US market])
  • Tricyclic antidepressants
Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Grace M Young, MD  Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Garry Wilkes, MBBS, FACEM  Director of Emergency Medicine, Bunbury Hospital, Western Australia; Medical Consultant, St John Ambulance, WA Ambulance Service; Adjunct Associate Professor, Edith Cowan University; Clinical Associate Professor, Rural Clinical School, University of Western Australia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH  Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

References

  1. Mitchell WG. Status epilepticus and acute serial seizures in children. J Child Neurol. Jan 2002;17 Suppl 1:S36-43. [Medline].

  2. Brevoord JC, Joosten KF, Arts WF, van Rooij RW, de Hoog M. Status epilepticus: clinical analysis of a treatment protocol based on midazolam and phenytoin. J Child Neurol. Jun 2005;20(6):476-81. [Medline].

  3. Papavasiliou AS, Kotsalis C, Paraskevoulakos E, Karagounis P, Rizou C, Bazigou H. Intravenous midazolam in convulsive status epilepticus in children with pharmacoresistant epilepsy. Epilepsy Behav. Apr 2009;14(4):661-4. [Medline].

  4. Holsti M, Dudley N, Schunk J, Adelgais K, Greenberg R, Olsen C, et al. Intranasal midazolam vs rectal diazepam for the home treatment of acute seizures in pediatric patients with epilepsy. Arch Pediatr Adolesc Med. Aug 2010;164(8):747-53. [Medline].

  5. Appleton R, Choonara I, Martland T,et al. The treatment of convulsive status epilepticus in children. The Status Epilepticus Working Party, Members of the Status Epilepticus Working Party. Arch Dis Child. Nov 2000;83(5):415-9. [Medline].

  6. Arzimanoglou A. Outcome of status epilepticus in children. Epilepsia. 2007;48 Suppl 8:91-3. [Medline].

  7. Bassin S, Smith TL, Bleck TP. Clinical review: status epilepticus. Crit Care. Apr 2002;6(2):137-42. [Medline].

  8. Chin RF, Neville BG, Peckham C, et al. Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. Lancet. Jul 15 2006;368(9531):222-9. [Medline].

  9. Choudhery V, Townend W. Best evidence topic reports. Lorazepam or diazepam in paediatric status epilepticus. Emerg Med J. Jun 2006;23(6):472-3. [Medline].

  10. Epilepsy Foundation of America's Working Group on Status Epilepticus. Treatment of convulsive status epilepticus. JAMA. Aug 18 1993;270(7):854-9. [Medline].

  11. Hanhan UA, Fiallos MR, Orlowski JP. Status epilepticus. Pediatr Clin North Am. Jun 2001;48(3):683-94. [Medline].

  12. Kalviainen R, Eriksson K, Parviainen I. Refractory generalised convulsive status epilepticus: a guide to treatment. CNS Drugs. 2005;19(9):759-68. [Medline].

  13. Korff CM, Nordli DR Jr. Diagnosis and management of nonconvulsive status epilepticus in children. Nat Clin Pract Neurol. Sep 2007;3(9):505-16. [Medline].

  14. Lang ES, Andruchow JE. Evidence-based emergency medicine. What is the preferred first-line therapy for status epilepticus?. Ann Emerg Med. Jul 2006;48(1):98-100. [Medline].

  15. Manno EM. New management strategies in the treatment of status epilepticus. Mayo Clin Proc. Apr 2003;78(4):508-18. [Medline].

  16. Meierkord H. The risk of epilepsy after status epilepticus in children and adults. Epilepsia. 2007;48 Suppl 8:94-5. [Medline].

  17. Neville BG, Chin RF, Scott RC. Childhood convulsive status epilepticus: epidemiology, management and outcome. Acta Neurol Scand Suppl. 2007;186:21-4. [Medline].

  18. Novorol CL, Chin RF, Scott RC. Outcome of convulsive status epilepticus: a review. Arch Dis Child. Nov 2007;92(11):948-51. [Medline].

  19. Pellock JM. Overview: definitions and classifications of seizure emergencies. J Child Neurol. May 2007;22(5 Suppl):9S-13S. [Medline].

  20. Prasad AN, Seshia SS. Status epilepticus in pediatric practice: neonate to adolescent. Adv Neurol. 2006;97:229-43. [Medline].

  21. [Best Evidence] Prasad K, Al-Roomi K, Krishnan PR, Sequeira R. Anticonvulsant therapy for status epilepticus. Cochrane Database Syst Rev. 2005;CD003723. [Medline].

  22. Raspall-Chaure M, Chin RF, Neville BG, Bedford H, Scott RC. The epidemiology of convulsive status epilepticus in children: a critical review. Epilepsia. Sep 2007;48(9):1652-63. [Medline].

  23. Riviello JJ Jr, Ashwal S, Hirtz D, et al. Practice parameter: diagnostic assessment of the child with status epilepticus (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. Nov 14 2006;67(9):1542-50. [Medline].

  24. Rosenow F, Hamer HM, Knake S. The epidemiology of convulsive and nonconvulsive status epilepticus. Epilepsia. 2007;48 Suppl 8:82-4. [Medline].

  25. Saz EU, Karapinar B, Ozcetin M, et al. Convulsive status epilepticus in children: Etiology, treatment protocol and outcome. Seizure. Dec 30 2010;[Medline].

  26. Scott RC, Kirkham FJ. Clinical update: childhood convulsive status epilepticus. Lancet. Sep 1 2007;370(9589):724-6. [Medline].

  27. Stephenson JB. Childhood convulsive status epilepticus. Lancet. Oct 14 2006;368(9544):1327-8; author reply 1328. [Medline].

  28. Sugai K. Treatment of convulsive status epilepticus in infants and young children in Japan. Acta Neurol Scand Suppl. 2007;186:62-70. [Medline].

  29. Sugai K. Treatment of convulsive status epilepticus in infants and young children in Japan. Acta Neurol Scand. Apr 2007;115(4 Suppl):62-70. [Medline].

  30. Treiman DM. Treatment of convulsive status epilepticus. Int Rev Neurobiol. 2007;81:273-85. [Medline].

  31. Yoshikawa H, Yamazaki S, Abe T, Oda Y. Midazolam as a first-line agent for status epilepticus in children. Brain Dev. Jun 2000;22(4):239-42. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.