Generalized tonic-clonic status epilepticus

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By Michael Mendoza MD and Robert L Beach MD PhD

Status epilepticus is a serious medical condition with annual incidence up to 120,000 cases in the United States alone, of which more than 20% result in death. Generalized tonic-clonic status epilepticus is the most life-threatening form of status epilepticus. Increased awareness of this condition is essential in the management of patients with this condition. This article discusses the definition, clinical presentation and evaluation, and the management of generalized tonic-clonic status epilepticus. Literature review on epidemiology, etiology, pathophysiology, and treatment of acute status epilepticus and refractory status epilepticus are reviewed.

Key points

  • Newer medications available in intravenous form are showing benefit in status epilepticus.
  • Basic science research suggests changes in synaptic properties including internalization of receptors that may correlate with refractory status epilepticus.
  • Continuous video EEG monitoring has assumed an essential role in diagnosis and treatment of refractory status epilepticus.


In This Article

Historical note and nomenclature
Clinical manifestations
Differential diagnosis
Diagnostic workup
Syndromes and diseases in which the seizure type occurs
Clinical vignette
References cited