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Status Epilepticus - Clinical Pathway - Further Diagnostic Testing

Status Epilepticus Clinical Pathway — ED, Inpatient and ICU

Further Diagnostic Testing

Consider the following:

LP
  • Opening pressure
  • Cell count with differential
  • Protein
  • Glucose
  • Gram stain
  • Culture
  • Consider obtaining additional (5 - 10 mL) CSF to hold for further tests:
    • Oligoclonal band profile (Blood in serum separator tube must be obtained at same time as CSF)
    • Fungal culture
    • Herpes simplex virus PCR
    • Enterovirus PCR
    • Parechovirus PCR (if < 3 years old)
    • Anti-NMDAR Antibody
    • Autoimmune Encephalopathy Panel
Imaging
  • Head CT
  • Consider magnetic resonance imaging when stable
Other Labs to Determine Etiology and Management
  • Consider:
    • Toxicology labs
    • Inborn errors of metabolism labs.
    • Anti-thyroid peroxidase antibodies
    • Anti-thyroglobulin antibodies
    • Bacterial cultures
    • Pregnancy test
    • Anti-NMDAR Antibody
    • Autoimmune Encephalopathy Panel
    • Genetic Epilepsy panel
Other Rx Considerations
  • Consider need for antibiotic and antiviral therapy
  • Consult Neurology
  • Consult Critical Care and plan for likely ICU admission
  • Consider EEG monitoring to evaluate for psychogenic SE or persisting EEG-only (subclinical) seizures after convulsive SE terminates

 

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