Definition

• Repeated seizures that fluctuate in severity and may last for hours or days
• most common in patients with temporal or frontal lobe epilepsy, or where epilepsy is associated with a learning disability
• most patients already have an established diagnosis of epilepsy and are taking treatment

Symptoms and signs

• Fluctuating conscious level without loss of consciousness
• Look for:
• confusion, agitation or aggressive behaviour
• drowsiness
• ataxia
• Previous history of cluster seizures or non-convulsive status

Differential diagnosis

• Drug toxicity
• Behavioural problems

Important underlying causes

• Recent changes in anti-epileptic drug therapy, dose or brand prescribed
• Underlying infection

Investigations

• FBC
• U&E
• Glucose
• If taking carbamazepine, phenobarbital or phenytoin, serum anticonvulsant concentrations

• Contact on-call neurology SpR for advice
• need for urgent EEG, admission and management
• avoid alteration in drug treatment before seeking advice
• Admission, if indicated, should be under care of consultant neurologist, if possible
• if patient admitted to general medical ward, notify as soon as possible clinical nurse specialist in epilepsy or consultant neurologist already concerned with patient's care

• If patient not admitted, send A&E card to clinical nurse specialist in epilepsy for urgent outpatient review
• If patient admitted, arrange outpatient review with neurology service