This is the current release of the guideline.

Definitions of the strength of the recommendations (A, B, C, U) and classification of the evidence (Class I through Class IV) are provided at the end of the "Major Recommendations" field.

Laboratory Studies

Should Blood Cultures and Lumbar Puncture (LP) Be Routinely Done in Children with Status Epilepticus (SE)?

Recommendations

1. There are insufficient data to support or refute whether blood cultures should be done on a routine basis in children in whom there is no clinical suspicion of infection (Level U).
2. There are insufficient data to support or refute whether LP should be done on a routine basis in children in whom there is no clinical suspicion of a central nervous system (CNS) infection (Level U).

Should AED Levels Be Routinely Obtained in Children Taking AEDs Who Develop SE?

Recommendation

1. AED levels should be considered when a child with epilepsy on AED prophylaxis develops SE (Level B, class II and III evidence).

Should Toxicology Testing Be Routinely Ordered in Children with SE?

Recommendation

1. Toxicology testing may be considered in children with SE, when no apparent etiology is immediately identified, as the frequency of ingestion as a diagnosis was at least 3.6% (Level C, class III evidence). To detect a specific ingestion, suspected because of the clinical history, it should be noted that a specific serum toxicology level is required, rather than simply urine toxicology screening.

Metabolic and Genetic Testing

Should Testing for Inborn Errors of Metabolism or Genetic (Chromosomal or Molecular) Studies Be Routinely Ordered in Children with SE?

Recommendations

1. Studies for inborn errors of metabolism may be considered when the initial evaluation reveals no etiology, especially if there is a preceding history suggestive of a metabolic disorder (Level C, class III evidence). The specific studies obtained are dependent on the history and the clinical examination. There is insufficient evidence to support or refute whether such studies should be done routinely (Level U).
2. There are insufficient data to support or refute whether genetic testing (chromosomal or molecular studies) should be done routinely in children with SE (Level U).

Electroencephalography (EEG)

Should an EEG Be Routinely Performed in the Evaluation of a Child with SE?

Recommendations

1. An EEG may be considered in a child presenting with new onset SE as it may determine whether there are focal or generalized abnormalities that may influence diagnostic and treatment decisions (Level C, class III evidence).
2. Although nonconvulsive SE (NCSE) occurs in children who present with SE, there are insufficient data to support or refute recommendations regarding whether an EEG should be obtained to establish this diagnosis (Level U).
3. An EEG may be considered in a child presenting with SE if the diagnosis of pseudostatus epilepticus is suspected (Level C, class III evidence).

Neuroimaging

Should Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) Be Performed in Children with SE?

Recommendations

1. Neuroimaging may be considered for the evaluation of the child with SE if there are clinical indications or if the etiology is unknown (Level C, class III evidence). If neuroimaging is done, it should only be done after the child is appropriately stabilized and the seizure activity controlled.
2. There is insufficient evidence to support or refute recommending routine neuroimaging (Level U).

Definitions:

Classification Scheme for Determining the Yield of Established Diagnostic and Screening Tests

Class I. A statistical,¹ population-based² sample of patients studied at a uniform point in time (usually early) during the course of the condition. All patients undergo the intervention of interest. The outcome, if not objective,⁵ is determined in an evaluation that is masked to the patients' clinical presentations.

Class II. A statistical, non-referral-clinic-based³ sample of patients studied at a uniform point in time (usually early) during the course of the condition. Most (>80%) patients undergo the intervention of interest. The outcome, if not objective, is determined in an evaluation that is masked to the patients' clinical presentations.

Class III. A selected, referral-clinic-based⁴ sample of patients studied during the course of the condition. Some patients undergo the intervention of interest. The outcome, if not objective,⁵ is determined in an evaluation by someone other than the treating physician.

Class IV. Expert opinion, case reports or any study not meeting criteria for class I to III.

Notes: (1) Statistical sample: a complete (consecutive), random or systematic (e.g., every third patient) sample of the available population with the disease; (2) Population-based: The available population for the study consists of all patients within a defined geographic region; (3) Non-referral-clinic-based: The available population for the study consists of all patients presenting to a primary care setting with the condition; (4) Referral-clinic-based: The available population for the study consists of all patients referred to a tertiary care or specialty setting. These patients may have been selected for more severe or unusual forms of the condition and thus may be less representative; (5) Objective: An outcome measure that is very unlikely to be affected by an observer's expectations (e.g., determination of death, the presence of a mass on head computed tomography [CT], serum B12 assays).

Strength of Recommendations

A = Established as effective, ineffective, or harmful for the given condition in the specified population. (Level A rating requires at least two consistent Class I studies.)

B = Probably effective, ineffective, or harmful for the given condition in the specified population. (Level B rating requires at least one Class I study or at least two consistent Class II studies.)

C = Possibly effective, ineffective, or harmful for the given condition in the specified population. (Level C rating requires at least one Class II study or two consistent Class III studies.)

U = Data inadequate or conflicting; given current knowledge, test is unproven.

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Not applicable: The guideline was not adapted from another source.

2006 Nov

American Academy of Neurology - Medical Specialty Society
Child Neurology Society - Medical Specialty Society

American Academy of Neurology (AAN)

Quality Standards Subcommittee
Practice Committee of the Child Neurology Society

Quality Standards Subcommittee Members: Jacqueline French, MD, FAAN (Co-Chair); Gary S. Gronseth, MD (Co-Chair); Charles E. Argoff, MD; Stephen Ashwal, MD, FAAN (ex-officio) (facilitator); Christopher Bever, Jr., MD, MBA, FAAN; John D. England, MD, FAAN; Gary M. Franklin, MD, MPH (ex-officio); Gary H. Friday, MD, MPH, FAAN; Larry B. Goldstein, MD, FAAN; Deborah Hirtz, MD (ex-officio); Robert G. Holloway, MD, MPH, FAAN; Donald J. Iverson, MD, FAAN; Leslie A. Morrison, MD; Clifford J. Schostal, MD; David J. Thurman, MD, MPH; William J. Weiner, MD, FAAN; Samuel Wiebe, MD

CNS Practice Committee Members: Carmela Tardo, MD (Chair); Bruce Cohen, MD (Vice-Chair); Diane K. Donley, MD; Bhuwan P. Garg, MD; Brian Grabert, MD; Michael Goldstein, MD; David Griesemer, MD; Edward Kovnar, MD; Augustin Legido, MD; Leslie Anne Morrison, MD; Ben Renfroe, MD; Shlomo Shinnar, MD; Gerald Silverboard, MD; Russell Snyder, MD; Dean Timmons, MD; William Turk, MD; Greg Yim, MD

American Academy of Pediatrics - Medical Specialty Society
American College of Emergency Physicians - Medical Specialty Society
American Epilepsy Society - Disease Specific Society

This is the current release of the guideline.

This summary was completed by ECRI Institute on May 14, 2007.

This NGC summary is based on the original guideline, which is copyrighted by the American Academy of Neurology.