Investigation in Status Epilepticus or after a First Seizure
Immediate 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.) 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:
For patients after a first seizure who are fully recovered and have no abnormal signs, CT can be done at a later date.