Nonconvulsive Status Epilepticus Resembling Clinical Absence with Atypical 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.

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Status epilepticus as presenting manifestation of H1N1 infection

International Journal of Epilepsy ◽

10.1016/j.ijep.2014.06.002 ◽

2015 ◽

Vol 02 (02) ◽

pp. 084-086 ◽

Cited By ~ 1

Author(s):

Aastha Takkar ◽

Manoj Goyal ◽

Manish Modi ◽

Parampreet Kharbanda ◽

Lakshminarayana Yaddanapudi ◽

...

Keyword(s):

Status Epilepticus ◽

Antiviral Treatment ◽

Neurological Complications ◽

Clinical Findings ◽

Convulsive Status Epilepticus ◽

H1n1 Pandemic ◽

H1n1 Infection ◽

Serological Tests ◽

History Of

Abstract Background During the global H1N1 pandemic, neurological complications were reported in approximately 6–10% of children suffering from H1N1 infection, but only rarely in adults. Generalized convulsive status epilepticus (GCSE) as a presenting manifestation of H1N1 infection in an adult is exceedingly rare and has not been reported in literature. We report a patient who presented to us with GCSE as a presenting manifestation of H1N1 infection who improved following appropriate antiviral treatment. Methods and results This 20-year-old gentleman presented to us with history of fever followed by GCSE of 24 h duration. He was treated symptomatically and was evaluated in detail. He was diagnosed to be suffering from H1N1 infection based on appropriate serological tests. After start of antiviral therapy, he improved and is doing well at 4 months follow up. Conclusion This case report further expands the spectrum of clinical findings associated with sporadic H1N1 infection. A possibility of H1N1 infection should be considered in all patients who present with GCSE without any obvious cause so that appropriate diagnostic tests and treatment can be carried out at the earliest.

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Ring Chromosome 20 with Nonconvulsive Status Epilepticus: Electroclinical Correlation of a Rare Epileptic Syndrome

Clinical EEG and Neuroscience ◽

10.1177/155005940503600305 ◽

2005 ◽

Vol 36 (3) ◽

pp. 151-160 ◽

Cited By ~ 5

Author(s):

Chaichon Locharernkul ◽

Alois Ebner ◽

Chinvorn Promchainant

Keyword(s):

Status Epilepticus ◽

Ring Chromosome ◽

Nonconvulsive Status Epilepticus ◽

Complex Partial Seizures ◽

Thai Women ◽

Verbal Stimuli ◽

Chromosome 20 ◽

History Of ◽

Clonic Seizures

The electroclinical features of two Thai women with ring chromosome 20 and nonconvulsive status epilepticus (NCSE) were studied. Both have also had generalized tonic-clonic seizures and complex partial seizures of varying frequencies since adolescence. Their intellectual functions were normal. Twenty-four-hour video/EEG telemetry recorded during the NCSE showed fluctuating consciousness between overt unresponsiveness and normal awareness. The EEG consisted of long-lasting generalized rhythmic 3–5 Hz sharp or slow waves with a few spikes, lasting several days. Despite the continuous discharges, the patients had relatively subtle clinical episodes of seizures, during which they were sometimes responsive to verbal stimuli. Intravenous antiepileptic drugs (AED) had little effect on the rhythmic EEG. No lesion in their MRIs contributed to NCSE. Ring chromosome 20 was found in 20% of female karyotype in both patients [46,XX, r(20) (p13 q13)/46,XX] but were negative in four healthy siblings. Oral AEDs decreased more than 75% of the overt CPS episodes in both patients at 22 and 26 months of follow-up but had no effect on the natural history of electrical NCSE. The patients' daily activities were minimally affected by the ongoing electrical discharges. These are the first two cases reported of ring chromosome 20 with NCSE in Thailand. Our patients present a rather benign and pharmacologically responsive course probably because of the low percentage of r(20) mosaicism. The electroclinical correlations in our cases raise the possibility that the mechanism of continuous rhythmic waves in this syndrome may be unrelated to epilepsy. Assessing the severity of this syndrome using both clinical seizures and EEG is crucial.

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Flakka-Induced Prolonged Psychosis

Case Reports in Psychiatry ◽

10.1155/2016/3460849 ◽

2016 ◽

Vol 2016 ◽

pp. 1-2 ◽

Cited By ~ 5

Author(s):

Craig Crespi

Keyword(s):

Hot Spot ◽

Symptomatic Treatment ◽

Altered Mental Status ◽

Mental States ◽

South Florida ◽

Residual Symptoms ◽

History Of ◽

Synthetic Drug ◽

Paranoid Psychosis

In South Florida, there has been a highly addictive new synthetic drug flooding the streets for people looking for a cheap high. Alpha-PVP, better known as Flakka, is an illegal substance that sells on the streets for as little as $5 a hit and delivers an instant high that can last from hours to days with lingering effects for weeks after it has been ingested. Although people use Flakka for its potential euphoric high, symptoms are known to easily escalate into frightening delusions, paranoid psychosis, extreme agitation, and a multitude of other altered mental states. According to the National Institute on Drug Abuse, Florida appears to be the nation’s hot spot for reports of Flakka. In this case report, a 17-year-old female with no prior psychiatric diagnosis presents to the hospital under a 72-hour involuntary placement for altered mental status with agitation and psychotic behaviors. After multiple days of symptomatic treatment with benzodiazepines and antipsychotics, the patient became coherent enough to give a history of a “friend” putting Flakka in her food at school as a joke. Although she continues to have residual symptoms including psychomotor agitation and slowing of cognition, she was alert, oriented, and able to be discharged home with proper follow-up.

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The efficacy of lamotrigine for atypical absence status epilepticus in a case of perioral myoclonia with absence

Epilepsy & Seizure ◽

10.3805/eands.8.1 ◽

2016 ◽

Vol 8 (1) ◽

pp. 1-8

Author(s):

Yusuke Takezawa ◽

Yosuke Kakisaka ◽

Keisuke Wakusawa ◽

Mamiko Ishitobi ◽

Naomi Hino-Fukuyo ◽

...

Keyword(s):

Status Epilepticus ◽

Absence Status ◽

Atypical Absence

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Lack of Neuronal Damage in Atypical Absence Status Epilepticus

Epilepsia ◽

10.1046/j.1528-1157.2002.10502.x ◽

2002 ◽

Vol 43 (12) ◽

pp. 1498-1501 ◽

Cited By ~ 12

Author(s):

Yukiyoshi Shirasaka

Keyword(s):

Status Epilepticus ◽

Neuronal Damage ◽

Absence Status ◽

Atypical Absence

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Idiopathic late-onset absence status epilepticus: A case report with an electroclinical 14 years follow-up

Seizure ◽

10.1016/j.seizure.2011.03.009 ◽

2011 ◽

Vol 20 (8) ◽

pp. 655-658 ◽

Cited By ~ 8

Author(s):

Stefano Pro ◽

Edoardo Vicenzini ◽

Franco Randi ◽

Patrizia Pulitano ◽

Oriano Mecarelli

Keyword(s):

Case Report ◽

Status Epilepticus ◽

Late Onset ◽

Absence Status

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Diagnostic Procedure and Therapeutic Approaches in Nonconvulsive Status Epilepticus (NCSE)

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2020.2.4.426 ◽

2020 ◽

Vol 2 (4) ◽

Author(s):

Zoryana Lebedyn

Keyword(s):

Status Epilepticus ◽

Focal Epilepsy ◽

Epileptic Seizures ◽

Nonconvulsive Status Epilepticus ◽

Major Type ◽

Absence Status ◽

Severe Motor ◽

Cognitive Deficiency ◽

Atypical Absence ◽

Few Data

Nonconvulsive epileptic seizures are major type of seizures of all patients with predominantly focal epilepsy. However, this problem is still insufficiently studied, the literature presents a few data on the diagnosis and treatment of nonconvulsive status epilepticus (NCSE). NCSE is a prolonged seizure, not accompanied by severe motor presentation. Such attacks occur much more often than previously thought. NCSE is divided into focal NCSE (complex partial status epilepticus), and generalized NCSE, often referred as absence status. The absence status divides into a typical absence status (presents with suppression of consciousness of various depths, myoclonic twitching of the eyelids, impoverishment of speech production and hallucinations), atypical absence status (presents with retardation of mental processes and eyelid myoclonus) and late absence status (long-term disorientation accompanied by cognitive deficiency and presents mainly in elderly patients). According to the available sources, more than 30% of patients in the intensive care units with impaired consciousness of unclear genesis are patients with NCSE. Use of antiepileptic drugs for intravenous administration opens better opportunities in the treatment of patients with status epilepticus and NCSE.

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

Case Reports in Neurological Medicine ◽

10.1155/2016/9238310 ◽

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.

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