STATUS epilepticus rarely occurs as the initial manifestation of an idiopathic epileptic disorder or in a patient whose seizures have been effectively controlled for a long time. Far too often, it follows the sudden cessation of maintenance therapy; there is no justification, therefore, for stopping medication before obtaining an electroencephalogram. Other causes of status epilepticus include infection, which is not necessarily confined to the central nervous system, occlusive cerebral vascular disease, metabolic and hypertensive encephalopathies, primary and secondary brain tumors, head trauma, degenerative central nervous system diseases of obscure origin, and, rarely, systemic diseases including the collagen diseases.
Diagnosis of the type of status epilepticus is usually made by history and by observation of at least one seizure. Because the patient loses consciousness in major motor epilepsy, the testimony of a competent witness is necessary. In focal motor epilepsy, the patient may remain conscious during a seizure and is thus