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Status epilepticus (SE), defined as 30 minutes of continuous seizure activity, is about three times more common in infants than in older children (150 vs. 50 per 100,000 per year). The American Academy of Neurology and the Practice Committee of the Child Neurology Society recently released evidence-based guidelines for diagnostic testing and evaluation of children with SE.
The committee graded the recommendations as follows:
A – Established as effective, ineffective, or harmful for the given condition in the specified population.
B – Probably effective, ineffective, or harmful.
C – Possibly effective, ineffective, or harmful.
U – Inadequate or conflicting data; given current knowledge, test is unproven.
Highlights of the guidelines include:
Data are insufficient to determine whether blood culture or lumbar puncture should be performed routinely in children in whom there is no clinical suspicion of infection (Level U).
Measurement of serum antiepileptic drug levels should be considered when a child with epilepsy who is receiving drug therapy develops SE (Level B).
Toxicology testing may be considered when the cause of SE is unknown (Level C).
Testing for inborn errors of metabolism may be considered when the initial evaluation for SE reveals no etiology (Level U).
Data are insufficient to determine whether genetic testing is warranted in children with SE (Level U).
An EEG may be considered in children who present with new-onset SE to determine whether there are focal or generalized abnormalities that may influence further diagnostic and therapeutic decisions (Level C).
Neuroimaging may be considered for evaluating children with SE if there are clinical indications or if the etiology is unknown (Level C).
The data are insufficient to recommend routine neuroimaging in children with SE (Level U).
Riviello JJ Jr 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 2006 Nov 14; 67:1542-50.
Comment
The generally low level of evidence that supports these recommendations reflects the lack of randomized clinical trials. Although there are few definitive statements within these guidelines, I believe they are helpful. Clearly, the evaluation of children with SE should be guided by the age of the patient, history, physical examination, and possible etiology. For example, a child with SE following head trauma should undergo an emergency CT scan. However, these guidelines do not support standardized, routine, extensive diagnostic evaluation for every child who develops SE.