Fact-sheet: Status epilepticus
Updated on 04/07/2026 at 8:49 AM
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Definition
Status epilepticus = seizure lasting more than 30 minutes, or at least 2 seizures without return to normal consciousness.
CT
Hypodensity of the cortical gray matter, subcortical white matter, splenium of the corpus callosum, and hippocampi.
Loss of gray-white matter differentiation.
MRI
T1 hypointense, T2 and FLAIR hyperintense lesions, often with diffusion restriction, loss of differentiation, and mild mass effect.
Mild cortical enhancement is possible.
Perfusion sequences most often show hyperperfusion.
Management
EEG (Electroencephalography):
- Although the diagnosis of epilepsy is essentially clinical, EEG is useful as it provides insight into the epileptic syndrome in children and helps determine the seizure type (focal, generalized, or secondarily generalized).
- Reveals epileptiform abnormalities (spikes, spike-and-wave, slow spikes, polyspikes, polyspike-and-wave).
- Can confirm or rule out the diagnosis of epilepsy (in the case of absence epilepsy).
- Useful in differential diagnosis in cases of confusion or impaired consciousness.
- However, a normal EEG does not formally rule out epilepsy.
Therapeutic principles:
- Anticonvulsants (clonazepam, diazepam, phenytoin, etc.)
- Symptomatic treatment (O2, metabolic support, etc.).
- Treatment of the underlying cause if possible.
Differential diagnosis
Psychogenic nonepileptic seizures
Postanoxic, metabolic, drug-induced encephalopathy, Creutzfeldt-Jakob disease.
