Pediatric status epilepticus

The study by Singh et al.¹ in this issue of Neurology® of new-onset seizures in children that present as status epilepticus (SE) expands our knowledge of this important area and provides valuable guidance for the diagnostic management of these children. New- onset seizures are common in children and SE is the presenting symptom in approximately 10%.²

The precise definition of SE is undergoing evolution and greatly depends on the question being asked and the conceptual basis. The standard definition is “a seizure or a series of seizures without full recovery in between lasting ≥30 minutes.”^3,4 The conceptual framework underlying this definition is that status must persist long enough to produce cerebral injury different from any underlying insult that led to the seizure. For this injury-based definition, 30 minutes remains appropriate, as studies that demonstrate seizure-induced injury, notably in prolonged febrile seizures, all find that it takes at least 30 minutes, and usually considerably longer, to produce detectable injury in children.⁵ The optimal duration for defining SE is somewhat less clear when the definition relates to the failure of inhibitory mechanisms that ordinarily terminate a seizure before it becomes prolonged.² Our studies reveal …