Diagnostic tests for status epilepticus vary by pretest probability

A prospective multicenter cohort study from the ICTAL registry, involving 1,123 adults admitted to 26 French ICUs for status epilepticus between 2018 and 2025, evaluated the diagnostic yield and therapeutic impact of etiologic workups including brain imaging, laboratory tests, lumbar puncture, toxicology screening, antiseizure medication assays, and paraneoplastic/autoimmune workup. The study reported that confirmation and reclassification rates varied widely by test and by clinical scenario, with brain MRI and CT associated with the highest rates of management changes (up to 58.3% and 56.9%, respectively), while toxicology screening and antiseizure medication assays showed the highest confirmation rates in their respective high-probability categories. The authors state that diagnostic yield and therapeutic impact are strongly influenced by pretest clinical probability, suggesting stratified diagnostic strategies could optimize etiologic identification.

Most relevant for: Clinicians managing adults admitted to the ICU for status epilepticus who require etiologic workup.

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