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

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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Nonconvulsive status epilepticus associated with Alzheimer’s disease mimicking symptomatic focal epilepsy following the resection of a frontal parasagittal meningioma

Surgical Neurology International ◽

10.25259/sni_709_2020 ◽

2020 ◽

Vol 11 ◽

pp. 469

Author(s):

Keisuke Abe ◽

Nobutaka Mukae ◽

Takato Morioka ◽

Yuhei Sangatsuda ◽

Ayumi Sakata ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Status Epilepticus ◽

Focal Epilepsy ◽

Nonconvulsive Status Epilepticus ◽

Histopathological Diagnosis ◽

Epileptogenic Lesion ◽

Consciousness Disorder ◽

Impaired Awareness ◽

The Right

Background: Epilepsies are frequent in patients with Alzheimer’s disease (AD); however, epilepsies in AD can easily go unrecognized because they usually present as focal impaired awareness seizures or nonconvulsive status epilepticus (NCSE) and can overlap with other symptoms of AD. Case Description: We performed an epilepsy surgery in a 69-year-old woman with progressive cognitive impairment and consciousness disorder, who was diagnosed with focal NCSE related to the resected meningioma in the right frontal parasagittal region. Intraoperative electrocorticography revealed localized periodic paroxysmal discharges with beta and gamma activities in the neighboring cortex where the meningioma existed. The histopathological diagnosis of AD was first made from the resected epileptogenic cortex. Conclusion: Even when there is a suspected epileptogenic lesion that could cause focal NCSE, AD should be ruled out in elderly patients with progressive cognitive decline.

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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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Nonconvulsive Status Epilepticus Resembling Clinical Absence with Atypical EEG Pattern

Case Reports in Neurological Medicine ◽

10.1155/2017/6987821 ◽

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.

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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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Nonconvulsive Status Epilepticus

10.1093/med/9780190228484.003.0021 ◽

2017 ◽

Author(s):

Frank W Drislane ◽

Susan T Herman ◽

Peter W Kaplan

Keyword(s):

Status Epilepticus ◽

Clinical Presentation ◽

Clinical Signs ◽

Nonconvulsive Status Epilepticus ◽

Eeg Monitoring ◽

Continuous Eeg ◽

Absence Status ◽

Continuous Eeg Monitoring ◽

Better Than ◽

Partial Status

The clinical presentation and encephalographic (EEG) findings of nonconvulsive status epilepticus (NCSE) can be complicated, making diagnosis difficult. There are generalized (e.g., absence status) and focal (e.g., aphasic status, complex partial status) forms. Some patients are responsive but have cognitive or other neurologic deficits; others are less responsive or even comatose. Increasingly, the diagnosis of NCSE is considered in intensive care unit patients. Here, without clinical signs of seizures such as convulsions, EEG is critical in diagnosis, but there is uncertainty about which EEG patterns represent seizures and which clinical situations and EEG patterns warrant aggressive treatment. Antiseizure medications are tailored to the NCSE type and the clinical condition. Treatment is often easier for NCSE, and the outcome better, than for convulsive SE, but this is not always true for critically ill patients with NCSE in the ICU, for whom continuous EEG monitoring is often crucial for diagnosis and management.

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