Complex partial status epilepticus accompanied by serious morbidity and mortality

Abstract

Nonconvulsive status epilepticus (NCSE) accounts for approximately 20% of all status epilepticus (SE). Although convulsive SE is recognized as a medical emergency, prompt diagnosis and treatment of patients with NCSE is often not emphasized because its consequences are thought to be benign. We report 10 patients with persistent neurologic deficits or death after well-documented NCSE in the form of complex partial status epilepticus (CPSE). All patients had prolonged CPSE lasting 36 hours or longer, as documented by clinical and EEG findings. Causes for CPSE were preexisting epilepsy with partial and secondarily generalized seizures (3 patients), vascular disease (2 patients), encephalitis (2 patients), and metabolic disease (1 patient); causes were unknown for two patients. Poor outcomes identified included persistent (lasting at least 3 months) or permanent cognitive or memory loss (5 patients), cognitive or memory loss plus motor and sensory dysfunction (3 patients), and death (3 patients). NCSE in the form of CPSE is not a benign entity. Serious morbidity and mortality may occur due to the adverse effects of prolonged seizures and as a result of acute brain disorders that precipitate the seizures.

Proceedings of the 2001 ECBC Scientific Conference on Chemical and Biological Defense Research, 6-8 March 2001, Marriott's Hunt Valley Inn, Hunt Valley, MD

“…Such association has been seen in previous studies from our laboratory with both anticholinergic as well as benzodiazepine drugs using soman challenge in this guinea pig model and has also been observed in nonhuman primate studies of anticonvulsant treatment of soman exposure (Lallement et al ,1998. Such an association between mortality and status epilepticus is well recognized in the clinical medical literature (Towne et al 1994; Krumholz et al 1995). The fact that control of nerve agent seizures is so strongly linked to protection from the lethal effects of nerve agents may explain the requirement for such high doses of atropine that have been routinely used in studies of the protective effects of carbamate pretreatment (Dirnhuber et al 1979;Maxwell et al 1988) or oxime therapies (Melchers et al 1994;Worek et al 1994; Koplovitz et al 1995).…”

Status Epilepticus: Risk Factors and Complications

“…There is evidence of neuronal injury in complex partial status epilepticus and NCSE associated with severe brain injury (62)(63)(64). DeGiorgio and colleagues (503 1) found elevated neuron-specific enolase in cerebrospinal fluid and serum during complex partial and myoclonic NCSE.…”

Cortical Regional Hyperperfusion in Nonconvulsive Status Epilepticus Measured by Dynamic Brain Perfusion CT

“…1 Mortality is reported to be mainly dependent on the underlying etiology and age. 4 Furthermore, NCSE has been shown to be an independent predictor of high mortality and morbidity and the occurrence of refractory status epilepticus. [5][6][7] There is evidence that 2 hours after the clinically successful cessation of convulsive activity, EEG demonstrates persistent epileptic seizure activity in 48% of patients, fulfilling, in 14%, the criteria of NCSE.…”