Status Epilepticus in the PICU: Quieting the Storm

Status epilepticus (SE), defined by either a prolonged seizure or a prolonged period of recurrent seizures without a return to baseline in-between seizures, is a neurological emergency frequently encountered in the pediatric intensive care unit (PICU). Pediatric SE, in addition to itself leading to PICU admission, occurs commonly in critically ill children. The clinical manifestations of SE are increasingly being recognized as presenting in a widely heterogeneous manner, particularly in the PICU. Subtler presentations can include altered mental status with or without suggestive motor movements. Thus, the initial fundamental task in managing pediatric SE is astute recognition and diagnosis, which often requires both clinical acumen and electroencephalography. This, in turn, allows for prompt management with concurrent evaluation and treatment. In this article, we will review the diagnosis, evaluation, and treatment of SE occurring in the setting of the PICU, with a focus on bringing the reader up-to-date on these topics.