Nonconvulsive Status Epilepticus on Electroencephalography in a Case With Subacute Sclerosing Panencephalitis

2006 ◽  
Vol 21 (3) ◽  
pp. 256-260
Author(s):  
Ömer Faruk Aydin ◽  
Nesrin Şenbil ◽  
Y. K. Yavuz Gürer
Keyword(s):  
Status Epilepticus ◽  
Subacute Sclerosing Panencephalitis ◽  
Closed Head Injury ◽  
High Amplitude ◽  
Nonconvulsive Status Epilepticus ◽  
Computed Tomographic ◽  
Cognitive Difficulties ◽  
Intravenous Diazepam ◽  
Electroencephalogram Eeg ◽  
The Brain

Subacute sclerosing panencephalitis is a neurodegenerative disease with a poor prognosis. We report a case of a 5Z\x-year-old boy who had emotional lability, cognitive difficulties, and myoclonia after a mild closed head injury. The magnetic resonance image of the brain and computed tomographic scan of the head were normal. His electroencephalogram (EEG) showed continuous nonconvulsive status epilepticus activity, which could not be suppressed with intravenous diazepam. After treatment with phenytoin for 2 days, an EEG showed periodic high-amplitude sharp-and-slow-wave complexes, which were also not suppressed with intravenous diazepam. Since the patient had measles at 5 months of age, subacute sclerosing panencephalitis was considered, and the diagnosis was confirmed by the presence of measles antibodies in cerebrospinal fluid. ( J Child Neurol 2006;21:256—260; DOI 10.2310/7010.2006.00056).

scholarly journals Nonconvulsive Status Epilepticus on Electroencephalography: An Atypical Presentation of Subacute Sclerosing Panencephalitis in Two Children

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Pratibha Singhi ◽  
Arushi Gahlot Saini ◽  
Jitendra Kumar Sahu
Keyword(s):  
Cerebrospinal Fluid ◽  
Status Epilepticus ◽  
Cognitive Decline ◽  
Neurodegenerative Disease ◽  
Slow Wave ◽  
Subacute Sclerosing Panencephalitis ◽  
Nonconvulsive Status Epilepticus ◽  
Atypical Presentation ◽  
Measles Antibodies

Subacute sclerosing panencephalitis is a neurodegenerative disease secondary to measles infection that usually has a typical presentation with progressive myoclonia, cognitive decline, and periodic slow-wave complexes on electroencephalography. We report two pediatric cases who presented with periodic myoclonic jerks and cognitive decline. In both cases, the electroencephalogram showed continuous nonconvulsive status epilepticus activity. Both had elevated measles antibodies in cerebrospinal fluid and blood. Pediatricians need to be aware of this atypical presentation of subacute sclerosing panencephalitis.

Nonconvulsive Status Epilepticus after Subarachnoid Hemorrhage

Neurosurgery ◽  
2002 ◽  
Vol 51 (5) ◽  
pp. 1136-1144 ◽  
Author(s):  
Lyle J. Dennis ◽  
Jan Claassen ◽  
Lawrence J. Hirsch ◽  
Ronald G. Emerson ◽  
E. Sander Connolly ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Neurological Deterioration ◽  
Nonconvulsive Status Epilepticus ◽  
Neurological Intensive Care Unit ◽  
Computed Tomographic ◽  
Neurological Intensive Care ◽  
Electrographic Seizures ◽  
Prolonged Coma

Abstract OBJECTIVE Although in-hospital seizures have been reported for 3 to 24% of patients with aneurysmal subarachnoid hemorrhage (SAH), nonconvulsive status epilepticus (NCSE) has not been previously described. We sought to determine the frequency and clinical features of NCSE among comatose patients with SAH. METHODS Between November 1997 and February 2000, we performed continuous electroencephalographic (cEEG) monitoring for at least 24 hours for all patients with aneurysmal SAH who were treated in our neurological intensive care unit and exhibited unexplained coma or neurological deterioration. NCSE was diagnosed when cEEG monitoring demonstrated continuous or repetitive electrographic seizures exceeding 1 hour in duration. Refractory NCSE was treated aggressively with intravenous anticonvulsant administration and continuous-infusion midazolam therapy. RESULTS Of 233 patients with SAH who survived the first 48 hours of hospitalization, 101 were stuporous or comatose at some point during their hospitalization. Twenty-six of those patients underwent cEEG monitoring, and eight were diagnosed as having NCSE, an average of 18 days (range, 5–38 d) after SAH. All eight patients were receiving prophylactic anticonvulsant therapy. Four patients were persistently comatose and four demonstrated deterioration to stupor or coma; only one exhibited overt tonicoclonic activity. A worst Hunt and Hess grade of IV or V, older age, ventricular drainage, and cerebral edema on computed tomographic scans were identified as risk factors for NCSE (all P < 0.01). NCSE was successfully terminated for five patients (63%), but only one experienced clinical improvement, which was transient; all eight patients eventually died after a period of prolonged coma. CONCLUSION cEEG monitoring detected NCSE for 8% of patients with SAH and otherwise unexplained coma or neurological deterioration. The seizures were highly refractory to therapy, and the prognosis for these patients was extremely poor. Routine postoperative cEEG monitoring of patients with SAH who are at high risk for NCSE, allowing earlier diagnosis and treatment, offers the best chance of improving the outcomes for patients with this disorder.

scholarly journals Cefepime-Induced Encephalopathy and Nonconvulsive Status Epilepticus: Dispelling an Artificial Dichotomy

2018 ◽  
Vol 9 (2) ◽  
pp. 100-104 ◽  
Author(s):  
Dmitry Tchapyjnikov ◽  
Matthew W. Luedke
Keyword(s):  
Status Epilepticus ◽  
Mental Status ◽  
Case Series ◽  
Generation Cephalosporin ◽  
Nonconvulsive Status Epilepticus ◽  
Fourth Generation ◽  
Definitive Treatment ◽  
Transient Improvement ◽  
Cephalosporin Antibiotic ◽  
Electroencephalogram Eeg

Cefepime is a fourth-generation cephalosporin antibiotic known to have neurotoxic side effects. Recent reports have described patients on cefepime presenting with altered mentation and concurrent triphasic wave discharges on electroencephalogram (EEG). Some have described this clinical presentation as cefepime-induced encephalopathy, while others have termed it as cefepime-induced nonconvulsive status epilepticus (NCSE). We report on 4 patients who developed cefepime-associated altered mentation with triphasic discharges on EEG. A benzodiazepine trial was attempted in 3 of the patients, all of whom had improvement in the frequency of the triphasic discharges, but only 2 of whom demonstrated a concurrent partial and transient improvement in mental status. All 4 patients had normalization of mental status upon discontinuation of cefepime. We provide a literature review of prior cases and propose that these reports, including those labeled as NCSE, are best described as a cefepime-induced encephalopathy with triphasic discharges as opposed to an ictal phenomenon. We contend that aggressive treatment with anti-seizure medications is not warranted and that cefepime discontinuation is the definitive treatment. This case series and review of the literature clarifies a long-standing terminological ambiguity in a unique clinical picture that can be encountered by the neurohospitalist or other providers.

Nonconvulsive Generalised Status Epilepticus Following Electroconvulsive Therapy

2000 ◽  
Vol 34 (2) ◽  
pp. 334-336 ◽  
Author(s):  
Alexander Srzich ◽  
John Turbott
Keyword(s):  
Differential Diagnosis ◽  
Status Epilepticus ◽  
Electroconvulsive Therapy ◽  
Mental State ◽  
Clinical Picture ◽  
Major Depressive Episode ◽  
Major Depressive ◽  
Intravenous Diazepam ◽  
Confusional States ◽  
Electroencephalogram Eeg

Objective: To describe a case of nonconvulsive generalised status epilepticus (NGS) following electroconvulsive therapy (ECT). Clinical picture: A 40-year-old woman suffering from a major depressive episode was treated with ECT following treatment with clonazepam, haloperidol and paroxetine. After her fifth treatment she became acutely confused. An electroencephalogram (EEG) at the time was consistent with NGS. Treatment and outcome: Initially intravenous diazepam and phenytoin were administered with an improvement in both her mental state and EEG. An oral anti-convulsant was continued. Conclusions: NGS is a rare though treatable cause of confusional states following ECT and should be considered in the differential diagnosis.

scholarly journals StatNet Electroencephalogram: A Fast and Reliable Option to Diagnose Nonconvulsive Status Epilepticus in Emergency Setting

2016 ◽  
Vol 43 (2) ◽  
pp. 254-260 ◽  
Author(s):  
Lady Diana Ladino ◽  
Alexandra Voll ◽  
Dianne Dash ◽  
Wes Sutherland ◽  
Lizbeth Hernández-Ronquillo ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Setup Time ◽  
Observer Agreement ◽  
Nonconvulsive Status Epilepticus ◽  
University Hospital ◽  
Emergency Setting ◽  
Study Quality ◽  
Hospital Emergency ◽  
Kappa Score ◽  
Electroencephalogram Eeg

AbstractBackground: The StatNet electrode set is a system that can be applied by a non-electroencephalogram (EEG) technologist after minimal training. The primary objectives of this study are to assess the quality and reliability of the StatNet recordings in comparison to the conventional EEG. Methods: Over 10 months, 19 patients with suspected nonconvulsive status epilepticus were included from university hospital emergency settings. Each patient received a StatNet EEG by a trained epilepsy fellow and a conventional EEG by registered technologists. We compared the studies in a blinded fashion, for the timeframe from EEG order to the setup time, start of acquisition, amount of artifact, and detection of abnormalities. The nonparametric Mann-Whitney two-sample t test was used for comparisons. The kappa score was used to assess reliability. Results: Mean age of patients was 61±16.3 (25-93) years. The inter-observer agreement for detection of abnormal findings was 0.83 for StatNet and 0.75 for conventional EEG. Nonconvulsive status epilepticus was detected in 10% (2/19) in both studies. The delay from the time of EEG requisition to acquisition was shorter in the StatNet (22.4±2.5 minutes) than the conventional EEG (217.7±44.6 minutes; p<0.0001). The setup time was also shorter in the StatNet (9.9±0.8 minutes) compared with the conventional EEG (17.8±0.8 minutes; p<0.0001). There was no difference in the percentage of artifact duration between the two studies (p=0.89). Conclusion: This study demonstrates that StatNet EEG is a practical and reliable tool in the emergency setting, which reduces the delay of testing compared with conventional EEG, without significant compromise of study quality.

Triphasic waves on electroencephalogram in patients with encephalopathy and their diagnosis significance. A review

2021 ◽  
pp. 38-43
Author(s):  
E. A. Baranova ◽  
M. V. Sinkin
Keyword(s):  
Status Epilepticus ◽  
High Amplitude ◽  
Subcortical White Matter ◽  
Nonconvulsive Status Epilepticus ◽  
Metabolic Disturbances ◽  
Metabolic Encephalopathy ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring ◽  
Low Amplitude ◽  
Eeg Pattern

Triphasic waves are high-amplitude (>70 µV) positive sharp transients preceded and followed by relatively low-amplitude negative waves. The distribution is generalized and tends to have a repetition rate of approximately 1 to 2 Hz. This EEG-pattern is traditionally associated with hepatic encephalopathy, although they have been observed in a wide array of neurological disorders including subcortical white-matter disease, infections, metabolic disturbances and nonconvulsive status epilepticus.American Clinical Neurophysiology Society suggested Standardized Critical Care EEG Terminology (2012). One of the goals was to eliminate terms with clinical connotations, such as ‘triphasic waves’, a term that implies a metabolic encephalopathy with no relationship to seizures for many clinicians. The term ‘triphasic waves’ was replaced by ‘Generalized periodic discharges (GPDs) with triphasic morphology’. The clinical significance ofthese waveforms and their relationship with seizures and prognosis has been debated, and differentiation between interictal patterns, patternsassociated with seizures, and the patterns representing nonconvulsive status epilepticus have been concluded to be a challenge. In cases of uncertainty, the decision to treat should follow on a thorough evaluation with a continuous EEG monitoring and using a short-acting benzodiazepine or non-sedating antiepileptic drugs in order to discern the effects of the pattern on the patient’s clinical exam and EEG.

Acute Tissue Tear Hemorrhages of the Brain: Computed Tomography and Clinicopathological Correlations

Neurosurgery ◽  
1990 ◽  
Vol 27 (2) ◽  
pp. 208-213 ◽  
Author(s):  
James E. Wilberger ◽  
William E. Rothfus ◽  
Janet Tabas ◽  
Andrew L. Goldberg ◽  
Ziad L. Deeb
Keyword(s):  
Computed Tomography ◽  
Head Injury ◽  
Head Injuries ◽  
Diffuse Axonal Injury ◽  
Closed Head Injury ◽  
Sensitive Information ◽  
Computed Tomographic ◽  
Clinicopathological Correlations ◽  
Closed Head ◽  
The Brain

Abstract Tissue tear hemorrhages (TTHs) are often seen on high-resolution computed tomographic scans after closed head injury. Generally, TTHs have been thought to be visible manifestations of more severe forms of diffuse axonal injury and thus portend a poor prognosis. Computed tomographic scans from 600 patients with head injuries were reviewed: 48 (8%) were found to have TTHs. The clinical spectrum of TTHs was characterized. No direct relationship could be established between either the presence or the number of TTHs and the severity and/or outcome from the head injury in this group, except that patients with TTHs in both the brain stem and the corpus callosum uniformly had a poor outcome. Magnetic resonance imaging provided more sensitive information than computed tomography in evaluating TTHs.

scholarly journals A case of nonconvulsive status epilepticus presenting as dissociative fugue

2013 ◽  
Vol 19 (4) ◽  
pp. 2
Author(s):  
Almila Erol ◽  
Ayla Yigit ◽  
Gozde Dogan ◽  
Behiye Ozer
Keyword(s):  
Status Epilepticus ◽  
Clonic Seizure ◽  
Nonconvulsive Status Epilepticus ◽  
Partial Status Epilepticus ◽  
Level Of Consciousness ◽  
Grand Mal ◽  
Clonic Seizures ◽  
Electroencephalogram Eeg ◽  
Video Eeg ◽  
Partial Status

<p><span>Nonconvulsive status epilepticus is characterised by changes in behaviour, memory, affect or level of consciousness. We report a case of nonconvulsive status epilepticus precipitated by carbamazepine that presented as dissociative fugue. The patient was a 49-year-old man. He first experienced a tonic-clonic seizure nine years previously and was diagnosed with <em>grand mal</em> epilepsy. He had been using carbamazepine 800 mg daily for the last eight years. He had not had any tonic-clonic seizures since carbamazepine was introduced but began to display behavioural disturbances periodically. He also left home many times, and remembered nothing about the period he had been away after he returned. He was hospitalised with a preliminary diagnosis of dissociative fugue. He had recurrent episodes with dissociative symptoms during his stay in the hospital. An electroencephalogram (EEG) and a 24-hour video EEG revealed nothing abnormal. An EEG recording taken during an episode indicated complex partial status epilepticus. Carbamazepine was substituted with valproate, and the patient was discharged in remission. </span></p>

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