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.
OBJECTIVE
To review evidence on the assessment of the child with status epilepticus (SE).


METHODS
Relevant literature were reviewed, abstracted, and classified. When data were missing, a minimum diagnostic yield was calculated. Recommendations were based on a four-tiered scheme of evidence classification.


RESULTS
Laboratory studies (Na(++) or other electrolytes, Ca(++), glucose) were abnormal in approximately 6% and are generally ordered as routine practice. When blood or spinal fluid cultures were done on these children, blood cultures were abnormal in at least 2.5% and a CNS infection was found in at least 12.8%. When antiepileptic drug (AED) levels were ordered in known epileptic children already taking AEDs, the levels were low in 32%. A total of 3.6% of children had evidence of ingestion. When studies for inborn errors of metabolism were done, an abnormality was found in 4.2%. Epileptiform abnormalities occurred in 43% of EEGs of children with SE and helped determine the nature and location of precipitating electroconvulsive events (8% generalized, 16% focal, and 19% both). Abnormalities on neuroimaging studies that may explain the etiology of SE were found in at least 8% of children.


CONCLUSIONS
Although common clinical practice is that blood cultures and lumbar puncture are obtained if there is a clinical suspicion of a systemic or CNS infection, there are insufficient data to support or refute recommendations as to whether blood cultures or lumbar puncture should be done on a routine basis in children in whom there is no clinical suspicion of a systemic or CNS infection (Level U). AED levels should be considered when a child with treated epilepsy develops SE (Level B). Toxicology studies and metabolic studies for inborn errors of metabolism may be considered in children with SE when there are clinical indicators for concern or when the initial evaluation reveals no etiology (Level C). An EEG may be considered in a child with SE as it may be helpful in determining whether there are focal or generalized epileptiform abnormalities that may guide further testing for the etiology of SE, when there is a suspicion of pseudostatus epilepticus (nonepileptic SE), or nonconvulsive SE, and may guide treatment (Level C). Neuroimaging may be considered after the child with SE has been stabilized if there are clinical indications or if the etiology is unknown (Level C). There is insufficient evidence to support or refute routine neuroimaging in a child presenting with SE (Level U).
Riviello
J J
JJ
Division of Epilepsy and Clinical Neurophysiology and the Critical Care Neurology Service, Department of Neurology, Children's Hospital, Boston, MA, USA.
Ashwal
S
S
Hirtz
D
D
Glauser
T
T
Ballaban-Gil
K
K
Kelley
K
K
Morton
L D
LD
Phillips
S
S
Sloan
E
E
Shinnar
S
S
D000927:Anticonvulsants / Q000032:analysis / Q000378:metabolism / Q000627:therapeutic use*; D001774:Blood Chemical Analysis / Q000592:standards; D020739:Brain Diseases, Metabolic, Inborn / Q000175:diagnosis / Q000235:genetics; D002648:Child; D019411:Clinical Laboratory Techniques / Q000592:standards*; D003141:Communicable Diseases / Q000150:complications / Q000175:diagnosis; D003952:Diagnostic Imaging / Q000592:standards; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis; D004569:Electroencephalography / Q000592:standards; D019317:Evidence-Based Medicine; D005820:Genetic Testing / Q000592:standards; D006801:Humans; D009462:Neurology / Q000592:standards*; D013129:Spinal Puncture / Q000592:standards; D013226:Status Epilepticus / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D014116:Toxicology / Q000592:standards
D000927:Anticonvulsants