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  • Status epilepticus is a life-threatening neurologic emergency.

  • Status epilepticus was traditionally defined as a seizure (or multiple seizures without full recovery of consciousness between seizures) lasting 30 minutes or longer, but the definition has been revised to encourage treatment of prolonged seizures within 5-10 minutes.

  • Etiology varies by age. The most common cause of status epilepticus in children under 5 years is febrile seizure.

  • Diagnostic evaluation may include routine blood work, lumbar puncture, neuroimaging, electroencephalogram, and antiseizure medication levels, depending on the circumstances under which status epilepticus occurs.

  • Several guidelines have been developed for treatment of status epilepticus. First-line treatment involves administration of a benzodiazepine, whereas loading doses of other anticonvulsants are used for seizures that do not terminate with initial benzodiazepine use.

  • Prognosis is dependent on underlying etiology.


This chapter will cover pediatric status epilepticus, including its epidemiology, etiology, treatment, and outcomes. Special attention will be paid to febrile status epilepticus and neonatal status epilepticus, which have different prognoses and, in the case of neonatal status epilepticus, different treatment.


Status epilepticus is the most common pediatric neurologic emergency, affecting an estimated 3 to 42 per 100,000 children annually worldwide based on several population-based studies.1 The true incidence may be higher, as nonconvulsive status epilepticus may go unrecognized or unreported. One study of 236 comatose patients of all ages with no overt signs of seizure showed that 8% of these patients met criteria for status epilepticus on electroencephalogram (EEG).2 Another study of 550 children in the intensive care unit undergoing EEG monitoring found that 30% of them had electrographic seizures, and of the children with electrographic seizures, 36% had electrographic status epilepticus.3 In addition, intermittent seizures without return to full consciousness may not initially be recognized as status epilepticus.

Status epilepticus occurs most commonly at the extremes of age. Studies of status epilepticus in children have consistently found that younger children are more susceptible.4-6 One study that included 364 children aged 1 month to 16 years found that children under the age of 2 years made up almost 50% of cases of status epilepticus in this population.4 This may be due to increased susceptibility to seizures in the developing brain,7 a higher incidence of acute symptomatic causes of seizures in young children, or the contribution of febrile status epilepticus to these figures.


Status epilepticus may be classified broadly into convulsive and nonconvulsive status epilepticus based on whether or not there is prominent motor involvement.8 Convulsive status epilepticus is defined by prominent motor features. The most common type of status epilepticus in children is generalized convulsive status epilepticus, which may be either primarily generalized or focal onset evolving to generalized.9 Other types of ...

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