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Table 16.1

Investigation in Status Epilepticus or after a First Seizure

Immediate

Blood glucose

Sodium, potassium, calcium, magnesium and creatinine

Arterial blood gases and pH (not required after first seizure)

Later

Full blood count

Blood culture (x2) if febrile

Liver function tests

Anticonvulsant levels (if on therapy), consider toxic screen

Serum (10 mL) and urine sample (50 mL) at 4°C for toxicology screen if poisoning suspected or cause of seizure unclear

ECG (NB A missed diagnosis of cardiac arrhythmia is more likely to lead to sudden death than a missed diagnosis of epilepsy. Look for long QT interval, conduction abnormality (e.g. left bundle branch block), Q waves indicative of previous myocardial infarction, evidence of left ventricular hypertrophy. If present, consider arrhythmia rather than seizure, arrange echocardiography and cardiology follow-up.)

Chest X-ray

Cranial CT scan*

Lumbar puncture (after CT) if suspected subarachnoid haemorrhage, meningitis or encephalitis

EEG (this test requires judgement as to when necessary: discuss with a neurologist)

* CT scan should be performed immediately after control of status epilepticus or after a first seizure if any of the following features is present:

  • Focal neurological deficit
  • Reduced conscious level
  • Fever
  • Recent head injury
  • Persistent headache
  • Known malignancy
  • Warfarin or other anticoagulation
  • HIV-AIDS

For patients after a first seizure who are fully recovered and have no abnormal signs, CT can be done at a later date.