Non-convulsive status epilepticus: usefulness of clinical features in selecting patients for urgent EEG

Abstract

Background: Non-convulsive status epilepticus (NCSE) is status epilepticus without obvious tonic-clonic activity. Patients with NCSE have altered mental state. An EEG is needed to confirm the diagnosis, but obtaining an EEG on every patient with altered mental state is not practical. Objective: To determine whether clinical features could be used to predict which patients were more likely to be in NCSE and thus in need of an urgent EEG. Methods: Over a six month period, all patients for whom an urgent EEG was ordered to identify NCSE were enrolled. Neurology residents examined the patients and filled out a questionnaire without knowledge of the EEG results. The patients were divided into two groups, NCSE and non-NCSE, depending on the EEG result. The clinical features were compared between the two groups. The sensitivity and specificity of the features were calculated. Results: 48 patients were enrolled, 12 in NCSE and 36 not in NCSE. Remote risk factors for seizures, severely impaired mental state, and ocular movement abnormalities were seen significantly more often in the NCSE group. The combined sensitivity of remote risk factors for seizures and ocular movement abnormalities was 100%. Conclusions: There are certain clinical features that are more likely to be present in patients in NCSE compared with other types of encephalopathy. Either remote risk factors for seizures or ocular movement abnormalities were seen in all patients in NCSE. These features may be used to select which patients should have an urgent EEG.

Catatonia ictal en el Servicio de Urgencia: una rara forma de presentación del estado epiléptico no convulsivo

“…Se han descrito criterios clínicos con el fin de aumentar la sensibilidad diagnóstica tales como la pesquisa de factores de riesgo para desarrollar un foco epileptógeno (accidente cerebrovascular, neurocirugía, tumor, meningoencefalitis) junto con algunas alteraciones en el examen físico, principalmente oculomotoras (nistagmos, parpadeo rítmico, desviación ocular mantenida) y neurovegetativas como la sudoración profusa 10 , sin embargo, la certeza diagnóstica requiere del EEG, que en nuestro caso tardó tres días en ser solicitado, período en que el paciente presentó neumonía por aspiración, complicación ampliamente descrita asociada al compromiso de conciencia 11 que podría haberse evitado disminuyendo el tiempo de hospitalización.…”

A case of nonconvulsive status epilepticus presenting as dissociative fugue

“…[6] Absence and complex partial status epilepticus are difficult to distinguish because clinical characteristics may overlap. [7] Dissociation has been described as a disruption of the normally integrated functions of consciousness, memory, identity, or perception of the environment and/or the body. [8] Dissociative disorders and epilepsy share a number of common symptoms that include amnesia, fugue, depersonalisation, derealisation, and identity change.…”

Non-convulsive status epilepticus in adults - an overview

“…Nevertheless, a remote condition facilitating the onset of an epileptic disorder, severely impaired consciousness and spontaneous eye movements (i.e. horizontal nystagmus) were significantly associated with the presence of NCSE [143]. A history of epilepsy may facilitate to think of NCSE; absence of such a history will not exclude the presence of NCSE in patients, since NCSE may often be the first manifestation of an epileptic condition in patients admitted to hospitals [30,144,145].…”