| Basic workup for causes of refractory status epilepticus |
| Screen | Disease/agent tested |
| Infectious | Recommended in most or all patients | (i) Serologic: bacterial and fungal cultures, RPR-VDRL, and HIV-1/2 immunoassay with confirmatory viral load if appropriate | (ii) CSF: cell counts, protein, glucose, bacterial and fungal stains and cultures, VDRL, PCR for HSV1, HSV2, VZV, EBV, HIV, and Mycobacterium tuberculosis | Recommended in immunocompromised patients in addition to above | (i) Serologic: IgG Cryptococcus species, IgM and IgG Histoplasma capsulatum, and IgG Toxoplasma gondii | (ii) Sputum: Mycobacterium tuberculosis GeneXpert | (iii) Serum and CSF: Toxoplasma IgG | (iv) CSF: eosinophils, silver stain for CNS fungi, PCR for JC virus, CMV, HHV6, EEE, Enterovirus, influenza A/B, WNV, Parvovirus, Listeria Ab, and measles (rubeola) | (v) Stool: adenovirus PCR and Enterovirus PCR |
| Vascular | (i) CTA or MRA and MR venography |
| Autoimmune/paraneoplastic | Recommended | (i) Serum and CSF paraneoplastic and autoimmune epilepsy antibody panel | To include antibodies to VGKC with LGI-1 and CASPR2, Ma2/Ta, DPPX, GAD65, NMDA, AMPA, GABA-B, GABA-A, glycine receptor, amphiphysin, CV-2/CRMP-5, neurexin-3 alpha, adenylate kinase, anti-neuronal nuclear antibody types 1 (Hu), 2 (Ri), and 3, Purkinje cell cytoplasmic antibody types 1 (Yo), Tr, and 2, and glial nuclear antibody type 1 | (ii) Serologic: also send for ANA, ANCA, anti-thyroid antibodies, anti-dsDNA, ESR, CRP, ENA, SPEP, and IFE. Antibodies for Jo-1, Ro, La, Scl-70, RF, and ACE; anti-tTG and anti-endomysium antibodies and cold and warm agglutinins | Optional: consider storing extra frozen CSF and serum for possible further autoimmune testing in a research lab |
| Neoplastic | Recommended: CT chest/abdomen/pelvis, scrotal ultrasound, mammogram, CSF cytology, flow cytometry, and pelvic MRI | Optional: bone marrow biopsy, whole-body PET-CT, and cancer serum markers |
| Metabolic | Recommended: LDH and ammonia | Considered: vitamin B1 level, B12 level, folate, lactate, pyruvate, CPK, and troponin; tests for mitochondrial disorder (lactate and pyruvate); serum triglycerides |
| Toxicological | Recommended: benzodiazepines, amphetamines, cocaine, fentanyl, alcohol, ecstasy, heavy metals, synthetic cannabinoids, and bath salts | Considered: extended opiate and overdose panel, LSD, heroin, PCP, and marijuana |
| Genetic | Considered: genetics consult, ceruloplasmin, and 24-hour urine copper |
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