Serotonin syndrome (SS) and status epilepticus (SE) are complex medical conditions that can have a dire prognosis if not treated efficiently. Patients exposed to drugs capable of inducing SS are also at risk of SE, even in the absence of a prior seizure history. Their overlapping presentations raise a clinical challenge due to their distinctive treatment approaches. 

We performed a literature review of 11 case reports found in the UMKC Health Sciences Library Catalog from the years 2000-2022 to identify cases of SS with SE to distinguish the potential risks, implicating conditions, establishing diagnosis, and treatment. Data search was limited to publications including SS AND SE. 

In multiple cases, recognition of SS and treatment of SS with cyproheptadine was delayed as the SE often masked symptoms of rigidity and myoclonus and complicated the clinical picture. Most of these patients were initially treated aggressively for SE and refractory seizures. In most cases, refractory symptoms and elevated temperatures after initial seizure activity along with medication recall prompted consideration of SS. 

All but one patient recovered with no sequelae. The one patient with neurologic sequelae had peripheral sensory and motor neuropathy which was actually attributed to prolonged shock rather than a direct sequela of SS or SE. 

SE occurring alongside SS may complicate the clinical picture and mask symptoms, delaying diagnosis and adequate treatment measures. Using the Hunter Serotonin Toxicity Criteria (HSTC) for SS diagnosis, serial or continuous EEG monitoring for SE diagnosis and monitoring, and a thorough medication review should be common practice in every patient case.