This is a summary of the American Academy of Neurology (AAN) and Child Neurology Society (CNS) evidence-based guideline reviewing all available evidence on the assessment of the child with status epilepticus (SE).

Status epilepticus (SE) is a medical condition characterized by repeated epileptic seizures without complete recovery between seizures, or by prolonged continuous seizure activity.

Status epilepticus (SE) in children, as in adults, is a life-threatening emergency that requires prompt recognition and immediate treatment.

Recommendations:

Blood cultures and Lumbar puncture

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).

Anti-epileptic drug (AED) levels

AED levels should be considered when a child with treated epilepsy develops SE (Level B).

Toxicology testing and Metabolic studies

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).

Genetic testing (chromosomal or molecular studies)

There are insufficient data to support or refute whether genetic testing
(chromosomal or molecular studies) should be done routinely in children with SE (Level U).

Electroencephalography (EEG)

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 studies (CT/MRI)

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).

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