Nonconvulsive Status Epilepticus: Overlooked and Undertreated

Points and Pearls Excerpt

• Nonconvulsive status epilepticus (NCSE) presents with persistent alteration in behavior or consciousness without convulsions, though subtle motor signs such as twitching or blinking may be present.
• There are 3 categories of NCSE: simple partial status epilepticus, complex partial status epilepti-cus, and absence status epilepticus.
• The only symptom seen consistently in NCSE is altered mental status, which can range from mild confusion to obtundation.
• NCSE often remains undiagnosed by psychiatrists and emergency clinicians due to failure to consider the diagnosis and lack of emergent electroencephalography (EEG).

Most Important References

• Brophy GM, Bell R, Claassen J, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17(1):3-23. (Guidelines)
• Trinka E, Cock H, Hesdorffer D, et al. A definition and classification of status epilepticus--report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia. 2015;56(10):1515-1523. (Review)
• Zehtabchi S, Abdel Baki SG, Grant AC. Electroencephalographic findings in consecutive emergency department patients with altered mental status: a preliminary report. Eur J Emerg Med. 2013;20(2):126-129. (Prospective observational study; 50 patients)
• Huff JS, Melnick ER, Tomaszewski CA, et al. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with seizures. Ann Emerg Med. 2014;63(4):437-447. (Clinical policy) 
• Glauser T, Shinnar S, Gloss D, et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016;16(1):48-61. (Guideline) 
• Treiman DM, Meyers PD, Walton NY, et al. A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med. 1998;339(12):792-798. (Randomized double-blind study; 384 patients) 
• Prasad M, Krishnan PR, Sequeira R, et al. Anticonvulsant therapy for status epilepticus. Cochrane Database Syst Rev. 2014;10(9):CD003723. (Cochrane review; 18 studies, 2755 patients)
• Sutter R, Fuhr P, Grize L, et al. Continuous video-EEG monitoring increases detection rate of nonconvulsive status epilepticus in the ICU. Epilepsia. 2011;52(3):453-457. (Review)