Non-convulsive status epilepticus in adults: clinical forms and treatment

Non-convulsive status epilepticus (NCSE) is one of the great diagnostic and therapeutic challenges of modern neurology. Because the clinical features of this disorder may be very discrete and sometimes hard to differentiate from normal behaviour, NCSE is usually overlooked and consequently not treated properly. It is important to be familiar with the clinical subtypes such as absence, simple and complex partial, and subtle status epilepticus because each requires tailored management. In order to improve overall care of patients with NCSE, strict diagnostic criteria are needed that should be based on clinical alterations and ictal electroencephalographic changes. NCSE should be terminated rapidly to prevent patients from serious injuries, particularly if consciousness is impaired.

[1]  Joshua R. Smith,et al.  Prevalence of nonconvulsive status epilepticus in comatose patients , 2000, Neurology.

[2]  T. Tomson,et al.  Nonconvulsive Status Epilepticus: High Incidence of Complex Partial Status , 1986, Epilepsia.

[3]  D. Stuss,et al.  Nonconvulsive generalized status epilepticus , 1986, Neurology.

[4]  C. Wasterlain,et al.  Status epilepticus: pathophysiology and management in adults , 2006, The Lancet Neurology.

[5]  D. Treiman,et al.  A progressive sequence of electroencephalographic changes during generalized convulsive status epilepticus , 1990, Epilepsy Research.

[6]  G. Celesia Modern concepts of status epilepticus. , 1976, JAMA.

[7]  H. Wieser Temporal lobe or psychomotor status epilepticus. A case report. , 1980, Electroencephalography and clinical neurophysiology.

[8]  Asla Pitkänen,et al.  MRI volumetry of the hippocampus, amygdala, entorhinal cortex, and perirhinal cortex after status epilepticus , 2000, Epilepsy Research.

[9]  H. Jasper,et al.  Book Reviews: Epilepsy and the Functional Anatomy of the Human Brain , 1954 .

[10]  R. Emerson,et al.  The ACNS Subcommittee on Research Terminology for Continuous EEG Monitoring: Proposed Standardized Terminology for Rhythmic and Periodic EEG Patterns Encountered in Critically Ill Patients , 2005, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[11]  T. Tomson,et al.  Nonconvulsive Status Epilepticus in Adults: Thirty‐Two Consecutive Patients from a General Hospital Population , 1992, Epilepsia.

[12]  F. Drislane Presentation, Evaluation, and Treatment of Nonconvulsive Status Epilepticus , 2000, Epilepsy & Behavior.

[13]  P. Kaplan,et al.  Assessing the outcomes in patients with nonconvulsive status epilepticus: nonconvulsive status epilepticus is underdiagnosed, potentially overtreated, and confounded by comorbidity. , 1999, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[14]  C. Heck,et al.  Serum neuron-specific enolase in the major subtypes of status epilepticus , 1999, Neurology.

[15]  D. Treiman,et al.  Subtle generalized convulsive status epilepticus , 1984 .

[16]  W. Oertel,et al.  Incidence of Status Epilepticus in Adults in Germany: A Prospective, Population‐Based Study , 2001, Epilepsia.

[17]  M. Holtkamp,et al.  Optical imaging reveals reduced seizure spread and propagation velocities in aged rat brain in vitro , 2003, Neurobiology of Aging.

[18]  N. Fountain,et al.  Assessment of acute morbidity and mortality in nonconvulsive status epilepticus , 2003, Neurology.

[19]  D. Fujikawa,et al.  Nonconvulsive status epilepticus with frontal features: quantitating severity of subclinical epileptiform discharges provides a marker for treatment efficacy, recurrence and outcome , 2002, Epilepsy Research.

[20]  J. Perlin,et al.  Estimating the economic burden of status epilepticus to the health care system , 2005, Seizure.

[21]  O. Markand,et al.  Pearls, Perils, and Pitfalls in the Use of the Electroencephalogram , 2003, Seminars in neurology.

[22]  P. Rutecki,et al.  A protocol for status epilepticus in a long-term care facility using rectal diazepam (Diastat). , 2001, Journal of the American Medical Directors Association.

[23]  A. Damasio,et al.  Electroencephalographic absence status with minimal behavior change. , 1979, Archives of neurology.

[24]  B. Meldrum,et al.  Systemic factors and epileptic brain damage. Prolonged seizures in paralyzed, artificially ventilated baboons. , 1973, Archives of neurology.

[25]  A. Husain,et al.  Non-convulsive status epilepticus: usefulness of clinical features in selecting patients for urgent EEG , 2003, Journal of neurology, neurosurgery, and psychiatry.

[26]  W. Löscher,et al.  Epileptogenesis and neuropathology after different types of status epilepticus induced by prolonged electrical stimulation of the basolateral amygdala in rats , 2003, Epilepsy Research.

[27]  M. Holtkamp,et al.  A "malignant" variant of status epilepticus. , 2005, Archives of neurology.

[28]  D. Prince,et al.  Clonazepam suppresses GABAB-mediated inhibition in thalamic relay neurons through effects in nucleus reticularis. , 1994, Journal of neurophysiology.

[29]  W. Hauser,et al.  A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia , 1996, Neurology.

[30]  B. Meldrum,et al.  Concept of activity-induced cell death in epilepsy: historical and contemporary perspectives. , 2002, Progress in brain research.

[31]  F. Bandini,et al.  Aphasic status epilepticus in multiple sclerosis. , 1996 .

[32]  R. Kuzniecky,et al.  A comparison of rectal diazepam gel and placebo for acute repetitive seizures. , 1998, The New England journal of medicine.

[33]  S. Mayer,et al.  Continuous EEG monitoring and midazolam infusion for refractory nonconvulsive status epilepticus , 2001, Neurology.

[34]  H. Kumashiro,et al.  Spike‐Wave Stupor , 1970, Folia psychiatrica et neurologica japonica.

[35]  K. Einhäupl,et al.  The management of refractory generalised convulsive and complex partial status epilepticus in three European countries: a survey among epileptologists and critical care neurologists , 2003, Journal of neurology, neurosurgery, and psychiatry.

[36]  T. Landis,et al.  Unilateral Limbic Epileptic Status Activity: Stereo EEG, Behavioral, and Cognitive Data , 1985, Epilepsia.

[37]  S. Shorvon,et al.  EFNS guideline on the management of status epilepticus , 2006, European journal of neurology.

[38]  E. Bromfield,et al.  Determinants of success in the use of oral levetiracetam in status epilepticus , 2006, Epilepsy & Behavior.

[39]  Mefkure Eraksoy,et al.  Recurrent absence status epilepticus: clinical and EEG characteristics , 2002, Seizure.

[40]  Jill N Peltzer,et al.  Refractory Idiopathic Absence Status Epilepticus: A Probable Paradoxical Effect of Phenytoin and Carbamazepine , 2000, Epilepsia.

[41]  H. Lueders,et al.  Complex partial status epilepticus , 1978, Neurology.

[42]  J. Fernández-Torre De novo absence status of late onset following withdrawal of lorazepam: a case report , 2001, Seizure.

[43]  P. Genton,et al.  Absence and myoclonic status epilepticus precipitated by antiepileptic drugs in idiopathic generalized epilepsy. , 2006, Brain : a journal of neurology.

[44]  B. Hermann,et al.  Protracted ictal confusion in elderly patients. , 2006, Archives of neurology.

[45]  H. Lüders,et al.  A semiological classification of status epilepticus. , 2005, Epileptic disorders : international epilepsy journal with videotape.

[46]  F. Drislane,et al.  Clinical implications of generalized electrographic status epilepticus , 1994, Epilepsy Research.

[47]  F. Andermann,et al.  Absence Status A Reappraisal following Review of Thirty‐eight Patients , 1972, Epilepsia.

[48]  M. Walker,et al.  Case of Simple Partial Status Epilepticus in Occipital Lobe Epilepsy Misdiagnosed as Migraine: Clinical, Electrophysiological, and Magnetic Resonance Imaging Characteristics , 1995, Epilepsia.

[49]  D. Treiman,et al.  Complex Partial Status Epilepticus , 1988, Advances in neurology.

[50]  R. Scott Buccal midazolam as rescue therapy for acute seizures , 2005, Lancet Neurology.

[51]  H. Gastaut,et al.  [The significance of certain epileptic fugues; concerning a clinical and electrical observation of temporal status epilepticus]. , 1956, Revue neurologique.

[52]  E. Niedermeyer,et al.  Petit Mai Status (“Spike‐Wave Stupor”) An electro‐clinical appraisal , 1965, Epilepsia.

[53]  Porter Rj,et al.  Petit mal status. , 1983 .

[54]  C. Tonon,et al.  Incidence and Short‐term Prognosis of Status Epilepticus in Adults in Bologna, Italy , 2003, Epilepsia.

[55]  P. Thomas,et al.  De Novo Absence Status Epilepticus as a Benzodiazepine Withdrawal Syndrome , 1993, Epilepsia.

[56]  K. Kanemoto,et al.  Intellectual Prognosis of Status Epilepticus in Adult Epilepsy Patients: Analysis with Wechsler Adult Intelligence Scale–Revised , 2005, Epilepsia.

[57]  C. Armon,et al.  Inhibitory simple partial (non-convulsive) status epilepticus after intracranial surgery , 2000, Journal of neurology, neurosurgery, and psychiatry.

[58]  F. Andermann,et al.  Valproate prevents the recurrence of absence status , 1989, Neurology.

[59]  J. Szaflarski,et al.  The use of levetiracetam in refractory status epilepticus , 2006, Seizure.

[60]  P. Kaplan Nonconvulsive Status Epilepticus in the Emergency Room , 1996, Epilepsia.

[61]  B. Uthman,et al.  A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. , 1998, The New England journal of medicine.

[62]  Prefrontal disturbances as the sole manifestation of simple partial nonconvulsive status epilepticus , 2006, Epilepsy & Behavior.

[63]  P. Kaplan,et al.  No, some types of nonconvulsive status epilepticus cause little permanent neurologic sequelae (or: « The cure may be worse than the disease ») , 2000, Neurophysiologie Clinique/Clinical Neurophysiology.

[64]  S. Shorvon Status Epilepticus: Its Clinical Features and Treatment in Children and Adults , 1994 .

[65]  M. Lennox,et al.  Epilepsy and Related Disorders , 1961 .

[66]  A. Mikulecká,et al.  Long-term behavioral and morphological consequences of nonconvulsive status epilepticus in rats , 2004, Epilepsy & Behavior.

[67]  O. Migneco,et al.  Nonconvulsive status epilepticus of frontal origin , 1999, Neurology.

[68]  M. Walker,et al.  Status Epilepticus in Idiopathic Generalized Epilepsy , 2005, Epilepsia.

[69]  M. Walker,et al.  Treatment of seizure emergencies: Convulsive and non-convulsive status epilepticus , 2006, Epilepsy Research.

[70]  R. Macdonald,et al.  Rapid Seizure-Induced Reduction of Benzodiazepine and Zn2+ Sensitivity of Hippocampal Dentate Granule Cell GABAA Receptors , 1997, The Journal of Neuroscience.

[71]  B. Ludwig,et al.  Prolonged partial complex status epilepticus , 1978, Neurology.

[72]  R. Hunter Status Epilepticus History, Incidence and Problems , 1959, Epilepsia.

[73]  E. Niedermeyer,et al.  Considerations of Nonconvulsive Status Epilepticus , 2000, Clinical EEG.

[74]  T. Fakhoury,et al.  Topiramate and status epilepticus: report of three cases , 2003, Epilepsy & Behavior.

[75]  A. Beaumanoir,et al.  'De novo' absence status of late onset , 1992, Neurology.

[76]  M. Aminoff,et al.  Clinical and EEG features of status epilepticus in comatose patients , 1992, Neurology.

[77]  M. Granner,et al.  Nonconvulsive Status Epilepticus: EEG Analysis in a Large Series , 1994, Epilepsia.

[78]  W. Poewe,et al.  Transient and permanent magnetic resonance imaging abnormalities after complex partial status epilepticus , 2006, Epilepsy & Behavior.

[79]  P. Gloor,et al.  Generalized Penicillin Epilepsy in the Cat: Correlation Between Electrophysiological Data and Distribution of 14C‐Penicillin in the Brain , 1978, Epilepsia.

[80]  T. Henry,et al.  Nonconvulsive Status Epilepticus in the Critically Ill Elderly , 1998, Epilepsia.

[81]  P. Humphrey,et al.  Prolonged complex partial status epilepticus: a case report. , 1988, Journal of neurology, neurosurgery, and psychiatry.

[82]  H. Meinardi,et al.  Non-convulsive status epilepticus: causes, treatment, and outcome in 65 patients. , 1996, Journal of neurology, neurosurgery, and psychiatry.

[83]  S. Kimura,et al.  Two Patients with Juvenile Myoclonic Epilepsy and Nonconvulsive Status Epilepticus , 1996, Epilepsia.

[84]  G. Cascino Nonconvulsive Status Epilepticus in Adults and Children , 1993, Epilepsia.

[85]  D. Spencer,et al.  Complex partial status epilepticus: A depth‐electrode study , 1985, Annals of neurology.

[86]  S. Shorvon The classification of status epilepticus. , 2005, Epileptic disorders : international epilepsy journal with videotape.

[87]  J. Dunne,et al.  Non-convulsive status epilepticus: a prospective study in an adult general hospital. , 1987, The Quarterly journal of medicine.

[88]  D. Hosford,et al.  Animal models of nonconvulsive status epilepticus. , 1999, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[89]  D. Labar,et al.  Aphasia as the Sole Manifestation of Simple Partial Status Epilepticus , 1992, Epilepsia.

[90]  C. Tassinari,et al.  Differentiation of “Absence Status” and “Temporal Lobe Status” * , 1971, Epilepsia.

[91]  N. Fountain,et al.  Pathophysiology of Status Epilepticus , 1995, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[92]  P. Gloor,et al.  Consciousness as a Neurological Concept in Epileptology: A Critical Review , 1986, Epilepsia.

[93]  D. Treiman Generalized Convulsive Status Epilepticus in the Adult , 1993, Epilepsia.

[94]  J. Detoledo Changing Presentation of Seizures with Aging: Clinical and Etiological Factors , 1999, Gerontology.

[95]  S. Livingston,et al.  Petit mal epilepsy. Results of a prolonged follow-up study of 117 patients. , 1965, JAMA.

[96]  P Jallon,et al.  Incidence of status epilepticus in French-speaking Switzerland , 2000, Neurology.

[97]  B. Meldrum,et al.  Prolonged epileptic seizures in primates. Ischemic cell change and its relation to ictal physiological events. , 1973, Archives of neurology.

[98]  J. O'leary,et al.  Petit mal epilepsy. , 1962, Pediatrics.

[99]  Josemir W Sander,et al.  Complex partial status epilepticus: a recurrent problem. , 1994, Journal of neurology, neurosurgery, and psychiatry.

[100]  W. A. Wilson,et al.  Prolonged twilight state and automatisms , 1974, Neurology.

[101]  Prolonged sensory or visceral symptoms: an under-diagnosed form of non-convulsive focal (simple partial) status epilepticus. , 1992, Journal of neurology, neurosurgery, and psychiatry.

[102]  W. Hauser,et al.  Incidence of status epilepticus in Rochester, Minnesota, 1965-1984 , 1998, Neurology.

[103]  D. Lowenstein,et al.  8. The relationship between electrographic seizure activity and neuronal injury , 1991, Epilepsy Research.

[104]  H. Meinardi,et al.  Simple partial status epilepticus: causes, treatment, and outcome in 47 patients. , 1996, Journal of neurology, neurosurgery, and psychiatry.