Status epilepticus in the pediatric emergency department

Status epilepticus is a common pediatric neurologic condition that often presents to the emergency department. Prior neurologic abnormalities or preexisting epilepsy are significant risk factors for the development of status epilepticus, although younger children more commonly present with either an acute symptomatic or febrile etiology. Prolonged seizure duration is associated with the development of resistance to anticonvulsants and the potential for permanent neurologic injury. Treatment strategies should focus on rapid administration of appropriate antiepileptic medications, with benzodiazepines used as the first-line agent. Nonconvulsive and subclinical status epilepticus may be difficult to identify. A high index of suspicion should be maintained for nonconvulsive status epilepticus, particularly in encephalopathic and critically ill children. Treatment of refractory status epilepticus often requires intensive care unit admission and the involvement of a neurologist. Initial diagnostic evaluation should include a broad differential and be focused on treatable causes, including central nervous system infections, electrolyte and metabolic disorders, and trauma.