eMedicine Specialties > Emergency Medicine > Pediatric

Pediatrics, Status Epilepticus: Differential Diagnoses & Workup

Author: Grace M Young, MD, Associate Professor, Department of Pediatrics, University of Maryland Medical Center
Contributor Information and Disclosures

Updated: Jul 18, 2008

Differential Diagnoses

Herpes Simplex
Toxicity, Cyanide
Herpes Simplex Encephalitis
Toxicity, Cyclic Antidepressants
Neoplasms, Brain
Toxicity, Heavy Metals
Pediatrics, Bacteremia and Sepsis
Toxicity, Lead
Pediatrics, Febrile Seizures
Toxicity, Local Anesthetics
Pediatrics, Meningitis and Encephalitis
Toxicity, Medication-Induced Dystonic Reactions
Toxicity, Amphetamine
Toxicity, Methamphetamine
Toxicity, Anticholinergic
Toxicity, Organophosphate and Carbamate
Toxicity, Antidepressant
Toxicity, Phencyclidine
Toxicity, Carbon Monoxide
Toxicity, Sympathomimetic
Toxicity, Cocaine

Other Problems to Be Considered

Posturing
Pseudoseizures or ticks
Shivering
Tremors

Workup

Laboratory Studies

Obtain laboratory studies based on age and likely etiologies.

  • Blood glucose level using immediate bedside testing (eg, Dextrostix), particularly if the child or other household members are dependent on insulin or other hypoglycemic agents
  • Electrolyte levels
  • Calcium and magnesium levels, particularly in neonates
  • ABG levels
  • Toxicology screen
  • Anticonvulsant levels (if indicated by history of ingestion or existent therapy)
  • WBC count: An elevated WBC count may be due to demargination, returning to reference ranges over 12-24 hours.
  • Carboxyhemoglobin levels

Imaging Studies

  • Stabilize all children before CT scanning or other imaging studies are performed. Obtain imaging studies based on likely etiologies.
  • Cervical spine radiographs, if potential trauma
  • A head CT scan is the best diagnostic imaging study, particularly if the following are suspected:
    • Hemorrhage
    • Midline shift
    • Mass lesion
  • MRI is not a diagnostic tool, unless it is immediately available and the child's cardiorespiratory status is stable.

Other Tests

  • Electroencephalography
    • For unremitting status epilepticus
    • Usually performed in a critical care setting

Procedures

  • Lumbar puncture with opening pressure
    • For prolonged status epilepticus of unknown etiology
    • For immunocompromised patients

More on Pediatrics, Status Epilepticus

Overview: Pediatrics, Status Epilepticus
Differential Diagnoses & Workup: Pediatrics, Status Epilepticus
Treatment & Medication: Pediatrics, Status Epilepticus
Follow-up: Pediatrics, Status Epilepticus
References
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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. 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].

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

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

  6. 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].

  7. 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].

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

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

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

  11. 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].

  12. 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].

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

  20. 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].

  21. 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].

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

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

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

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

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Further Reading

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Keywords

status epilepticus, SE, epilepsy, status epilepticus in children, seizure, febrile seizures, continuous seizure activity, hypoxia, hypercarbia, hyperthermia, tachycardia, hypertension, hyperglycemia, hyperkalemia, hypoglycemia, lactic acidosis, respiratory acidosis, epilepsy, sepsis, meningitis, respiratory distress, meningismus

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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.

Medical Editor

Garry Wilkes, MBBS, FACEM, Director of Emergency Medicine, Bunbury Health Service, Western Australia Country Health Service; Adjunct Associate Professor, School of Exercise, Biomedical and Health Sciences, Faculty of Computing, Health and Science, Edith Cowan University; Medical Director, St John Ambulance Service
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Wayne Wolfram, MD, MPH, Clinical Associate Professor, Departments of Pediatrics, Children's Hospital and University of Cincinnati
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.

CME Editor

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, Assistant 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: none None None

 
 
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