non-convulsive status epilepticus

Introduction

Prolonged generalized partial seizures or absence seizures.

Etiology

• may complicate postictal state of convulsive status epilepticus

Epidemiology

• 52% with acute medical illness involving CNS
  • 13% with history of epilepsy
• 31% with previous history of epilepsy, but no acute illness
• 17% with no acute illness & no history of epilepsy
• frequently unrecognized

Clinical manifestations

• no frank convulsive movements
• mental status changes variable
  • cognitive impairment
  • behavioral changes
    • repeated episodes of staring
    • lip smacking
  • obtundation, nonresponsiveness to coma (33%)
  • post-ichtal lethargy
  • intermittent periods of baseline mental status
• may present as persistent altered mental status after treatment of convulsive status epilepticus
  • waxing & waning
  • focal neurologic deficits (aphasia, dysarthria ...)
• suspect in critically ill patient with altered mental status without clear cause

Diagnostic criteria

• video EEG monitoring
• paradoxical improvement in mental status with low-dose benzodiazepine

Diagnostic procedures

• EEG monitoring
  • continuous seizure activity on EEG
  • 24 hour monitor, 48 hours if comatose

Management

• correct hypoglycemia
  • 50 mL of 50% dextrose with 100 mg of thiamine IV
• not acutely life-threatening
• does not require immediate or aggressive management
• bolus administration of patient's maintenance therapy if subtherapeutic
• prognosis
  • overall mortality 18%
  • comorbidity increases mortality

More general terms

• status epilepticus