scholarly journals Pediatric Absence Status Epilepticus: Prolonged Altered Mental Status in an 8-Year-Old Boy

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Scott J. Adams ◽  
Melody Wong ◽  
Tahereh Haji ◽  
Shahmir Sohail ◽  
Salah Almubarak
Keyword(s):  
Status Epilepticus ◽  
Mental Status ◽  
Clinical Presentation ◽  
Altered Mental Status ◽  
Impaired Consciousness ◽  
Idiopathic Generalized Epilepsy ◽  
Altered Sensorium ◽  
Absence Status ◽  
Generalized Epilepsy

Absence status epilepticus is characterized by a prolonged state of impaired consciousness or altered sensorium with generalized electroencephalographic abnormalities. It is most commonly diagnosed in patients with known idiopathic generalized epilepsy; however, it may also be the first presentation of epilepsy. Due to the subtle and variable manifestations of the condition, absence status epilepticus may be underrecognized, particularly in children. We present the case of an 8-year-old boy who experienced two episodes of prolonged altered mental status, subsequently determined to be absence status epilepticus with idiopathic generalized epilepsy with phantom absences. We discuss the classification, pathophysiology, clinical presentation, and electroencephalographic findings of pediatric absence status epilepticus and provide a practical overview for management.

scholarly journals A prolonged altered mental status: is it absence status epilepticus?

2013 ◽  
Vol 2013 (jun19 1) ◽  
pp. bcr2013009845-bcr2013009845
Author(s):  
O. S. M. Amin
Keyword(s):  
Status Epilepticus ◽  
Mental Status ◽  
Altered Mental Status ◽  
Absence Status

scholarly journals Fat Embolism and Nonconvulsive Status Epilepticus

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Yanetsy Olivera Arencibia ◽  
Mai Vo ◽  
Jennifer Kinaga ◽  
Jorge Uribe ◽  
Gloria Velasquez ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Mental Status ◽  
Supportive Therapy ◽  
Altered Mental Status ◽  
Fat Embolism ◽  
Nonconvulsive Status Epilepticus ◽  
Altered Level ◽  
Fat Embolism Syndrome ◽  
Embolism Syndrome ◽  
Wide Range

Fat embolism syndrome (FES) typically occurs following orthopedic trauma and may present with altered mental status and even coma. Nonconvulsive status epilepticus is an electroclinical state associated with an altered level of consciousness but lacking convulsive motor activity and has been reported in fat embolism. The diagnosis is clinical and is treated with supportive care, antiepileptic therapy, and sedation. A 56-year-old male presented with altered mental status following internal fixation for an acute right femur fracture due to a motor vehicle accident 24 hours earlier. Continued neuromonitoring revealed nonconvulsive status epilepticus. Magnetic resonance imaging of the brain showed multiple bilateral acute cerebral infarcts with a specific pattern favoring the diagnosis of fat embolism syndrome. He was found to have a significant right to left intracardiac shunt on a transesophageal echocardiogram. He improved substantially over time with supportive therapy, was successfully extubated on day 6, and discharged to inpatient rehabilitation on postoperative day 15. Fat embolisms can result in a wide range of neurologic manifestations. Nonrefractory nonconvulsive status epilepticus that responds to antiepileptic drugs, sedation, and supportive therapy can have a favorable outcome. A high index of suspicion and early recognition reduces the chances of unnecessary interventions and may improve survival.

scholarly journals Non-convulsive status epilepticus: an often-overlooked etiology of syndrome of inappropriate antidiuretic hormone secretion

2017 ◽  
Vol 5 (5) ◽  
pp. 2251
Author(s):  
Elizabeth Davis ◽  
Rima Chakraborty
Keyword(s):  
Differential Diagnosis ◽  
Status Epilepticus ◽  
Mental Status ◽  
Hormone Secretion ◽  
Altered Mental Status ◽  
Convulsive Status Epilepticus ◽  
Chronic Medical Conditions ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Chronic Hyponatremia

Altered mental status is a common presenting complaint in adult medicine with a broad differential diagnosis. When found in the context of chronic medical conditions, less common etiologies can be overlooked. We present a case of acute altered mental status thought to be secondary to acute on chronic hyponatremia in the context of syndrome of inappropriate antidiuretic hormone secretion (SIADH), eventually diagnosed as non-convulsive status epilepticus, partial type. We report the case of a 67-year-old patient with known SIADH of unknown etiology, hypertension, chronic pancreatitis and chronic obstructive pulmonary disease (COPD) who presented with fatigue, myalgia, decreased urine output. On presentation patient also had profound acute on chronic hyponatremia. During sodium correction, the patient developed an acute, progressive decline in mental status. Vital signs remained stable and workup including LP and MRI were negative. Initial electroencephalographic (EEG) showed no definitive seizure activity, but did show bifrontal focal continuous slowing. The patient’s mental status continued to decline and upon further evaluation it was suggested that the EEG findings and the patient’s progressive AMS could be compatible with non-convulsive status epilepticus. The patient received loading doses of IV lorazepam and levetiracetam and within 48 hours after initial treatment was back to baseline. Non-convulsive status epilepticus is a common, but heterogeneous subclass of status epilepticus that is difficult to diagnose. This case demonstrates the difficulty of diagnosing normalized corrected Shannon entropy (NCSE) in the context of other chronic medical conditions and the importance of including it on any differential diagnosis for acute change in mental status. 

scholarly journals Status epilepticus in patients with genetic (idiopathic) generalized epilepsy

2019 ◽  
Vol Volume 15 ◽  
pp. 1585-1592 ◽  
Author(s):  
Magdalena Bosak ◽  
Dominika Pawełczak ◽  
Agnieszka Słowik
Keyword(s):  
Status Epilepticus ◽  
Idiopathic Generalized Epilepsy ◽  
Generalized Epilepsy

scholarly journals Nonconvulsive Status Epilepticus Resembling Clinical Absence with Atypical EEG Pattern

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Channaiah Srikanth Mysore ◽  
Najib Murr ◽  
Rana Zabad ◽  
John Bertoni
Keyword(s):  
Status Epilepticus ◽  
Altered Mental Status ◽  
Progressive Multiple Sclerosis ◽  
Absence Status ◽  
History Of ◽  
Eeg Changes ◽  
Neurological Conditions ◽  
Atypical Absence ◽  
Eeg Pattern

Objective. We are reporting two cases: a patient with steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT) and another patient with secondary progressive multiple sclerosis (SPMS), both presenting with altered mental status (AMS) and later diagnosed with nonconvulsive atypical absence status epilepticus (AS), with atypical EEG changes. Methods. A report of two cases. Results. A patient with history of SREAT and the other with SPMS had multiple admissions due to AMS. For both, EEG revealed the presence of a high voltage generalized sharply contoured theta activity. A diagnosis of NCSE with clinical features of AS was made based on both clinical and EEG features. There was significant clinical and electrographic improvement with administration of levetiracetam for both patients in addition to sodium valproate and Solumedrol for the SREAT patient. Both patients continued to be seizure free on follow-up few months later. Conclusions. This is a report of two cases of atypical AS, with atypical EEG, in patients with different neurological conditions. Prompt clinical and EEG recovery occurred following appropriate medical treatment. We think that this condition might be underreported and could significantly benefit from prompt treatment when appropriately diagnosed.

Responsive Neurostimulation of the Thalamus Improves Seizure Control in Idiopathic Generalized Epilepsy: A Case Report

Neurosurgery ◽  
2020 ◽  
Vol 87 (5) ◽  
pp. E578-E583 ◽  
Author(s):  
Vasileios Kokkinos ◽  
Alexandra Urban ◽  
Nathaniel D Sisterson ◽  
Ningfei Li ◽  
Danielle Corson ◽  
...  
Keyword(s):  
Case Report ◽  
Neural Activity ◽  
Seizure Control ◽  
Clinical Presentation ◽  
Idiopathic Generalized Epilepsy ◽  
Absence Seizures ◽  
Level Of Consciousness ◽  
Spike Wave Discharges ◽  
Generalized Epilepsy ◽  
Spike Wave

Abstract BACKGROUND AND IMPORTANCE At least 25% of patients with idiopathic generalized epilepsy do not obtain adequate seizure control with medication. This report describes the first use of responsive neurostimulation (RNS), bilaterally targeting the centromedian/ventrolateral (CM/VL) region in a patient with drug-refractory Jeavons syndrome (eyelid myoclonia with absences). CLINICAL PRESENTATION A patient, diagnosed with eyelid myoclonia with absences (EMA) and refractory to medication, was offered RNS treatment in the CM/VL region of the thalamus. Stimulation was triggered by thalamic neural activity having morphological, spectral, and synchronous features that corresponded to 3- to 5-Hz spike-wave discharges recorded on prior scalp electroencephalography. CONCLUSION RNS decreased daily absence seizures from a mean of 60 to ≤10 and maintained the patient's level of consciousness during the occurring episodes. This therapy should be evaluated further for its potential to treat patients with pharmaco-refractory generalized epilepsy.

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