A new guideline for the diagnosis of status epilepticus in children has been developed by the American Academy of Neurology and the Child Neurology Society. Published in the November 14 Neurology, the guideline focuses on the assessment of antiepileptic drug (AED) levels and EEG results but also recommends that clinicians consider toxicologic, metabolic, and infectious studies when determining the cause.

The authors noted that previous guidelines were developed for the treatment, not the diagnosis, of status epilepticus, and that they were based on a consensus rather than evidence. The investigators developed the new guideline after pooling data from relevant studies from 1970 to 2005 that included at least 20 subjects ages 1 month to 19 years who had experienced seizures.

If status epilepticus develops in patients using AEDs to combat epilepsy, it is possible that drug levels are low due to therapeutic response, inadequate dosing, noncompliance, or withdrawal. In the literature, 32% of patients presenting with status epilepticus had low AED levels. Although low AED levels "were not necessarily the cause of status epilepticus," the authors advised that clinicians consider it during diagnosis.

Within the reviewed literature, ingestion of a toxic substance was diagnosed as a cause of status epilepticus in at least 3.6% of children, leading the investigators to recommend that clinicians examine specific serum toxicology levels if no other cause is apparent. Tests for inborn metabolic errors and neuroimaging to detect lesions yielded diagnoses in 4.2% and 7.8% of cases, respectively. The guideline recognizes these tests as useful if etiology is undetermined; however, the investigators could not support or refute routine use.

Inconclusive evidence was found for the use of EEG to diagnose nonconvulsive status epilepticus and the routine use of blood cultures and lumbar puncture when CNS infections are suspected.

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