Status Epilepticus in the Pediatric Emergency Department

Status epilepticus (SE) is a common childhood condition often seen by emergency physicians. It occurs at a frequency of between 17 and 23 per 100 000, higher in younger children. Risk factors for SE include an acute symptomatic etiology, and for those children with underlying epilepsy, a remote symptomatic etiology and a younger age of epilepsy onset. Treatment paradigms vary by institution but should be rapid and aggressive. Underdosing of anticonvulsants and excessive lag between doses should be avoided. Identification of nonconvulsive and subclinical SE is often missed and requires a high index of suspicion. Refractory SE often requires an intensive care unit admission and the involvement of a neurologist. Etiologic evaluation should include a broad differential and be focused initially on treatable causes, including central nervous system infections, electrolyte and metabolic disorders, and trauma.