Relevance of clinical context in the diagnostic-therapeutic approach to status epilepticus

What is it about?

The International League Against Epilepsy (ILAE) has recently published a proposal of definition and classification of Status Epilepticus (SE), a condition characterized by the recurrence of many epileptic seizures without recovering in-between. A section of this proposal, named “Axis 2 (etiology)”, mentions that SE may occur in patients who used to have seizures before (with epilepsy) or in patients without a history of seizures. In our document, we highlight the fact that diagnostic procedures and treatment should be differentiated in these two situations. In particular, patients who have a history of epilepsy may experience seizure because they do not take their medications as prescribed, because they take the wrong medication, or because their epilepsy is severe and SE is quite expected in their condition. In these situations, other causes may be sought only after obvious triggering factors are excluded. Conversely, a patients with SE of new onset should undergo many analyses to understand the cause of this condition, including laboratory testing and brain imaging (CT scan or MRI). The distinction between patients with or without epilepsy is useful to avoid unnecessary tests and to speed up treatment.

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Why is it important?

Our observations suggest that the definition of the clinical context of appearance of status epilepticus is important for diagnosis and treatment.