Review article: Convulsive and non‐convulsive status epilepticus: An emergency medicine perspective

Abstract

Status epilepticus (SE) is divided into convulsive and non-convulsive types; both are associated with significant morbidity and mortality. Although convulsive SE is easily recognized, non-convulsive SE remains an elusive diagnosis as physical signs are varied and subtle. Successful management depends on a comprehensive approach that involves diagnostic testing and pharmacological interventions while ensuring cerebral oxygenation and perfusion at all times. There are a limited number of well-designed studies to support the development of evidence-based recommendations for the management of SE, especially for the management of non-convulsive status. Benzodiazepines, specifically lorazepam, continue to be the most commonly recommended first-line therapy; best treatment for refractory status cases depends on resources available and must be tailored to the individual institution. In order to facilitate care, it is recommended that each institution develop a management protocol for these patients.

Cerebral Hyperperfusion Syndrome Associated With Non-convulsive Status Epilepticus Following Superficial Temporal Artery-Middle Cerebral Artery Anastomosis -Case Report-

“…19) NCSE is defined as a change in behavior and/or mental process from the baseline associated with ongoing seizure activity or continuous epileptiform discharges on EEG in the absence of convulsive symptoms. 2,16,20) Epileptic activity causes increased metabolic demand in the involved cortex, which is accompanied by temporarily increased regional cerebral perfusion. 6,8) Since PLEDs are one of the EEG patterns in patients with NCSE, 2,9) the pathophysiology of``ictal'' hyperperfusion could be similar to that observed in our case.…”

“…1) Mortality is reported to be mainly dependent on underlying etiology and age, but NCSE carries a poor prognosis so prompt diagnosis and subsequent treatment is important. 2,16,20) SPECT and ultrasonography can clearly demonstrate the hyperperfusion state, but cannot detect neuronal function, especially neuronal excitability. In contrast to hyperperfusion after CEA, hyperperfusion is delayed after STA-MCA anastomosis.…”

“…With the diagnosis of status epilepticus, the first recommended treatment is rapid administration of antiepileptic drugs such as diazepam, phenobarbital, and phenytoin. 16,20) If prolonged seizure activity is noted, anesthesia with barbiturate or propofol may be indicated. 16,20) If increased CBF cannot overcome the increased metabolic demand during status epilepticus, neuronal ischemia can occur and free radicals are produced.…”

“…16,20) If prolonged seizure activity is noted, anesthesia with barbiturate or propofol may be indicated. 16,20) If increased CBF cannot overcome the increased metabolic demand during status epilepticus, neuronal ischemia can occur and free radicals are produced. Edaravone inhibits lipid peroxidation and vascular endothelial cell injury, and ameliorates brain edema and tissue injury.…”

An Emergency Medicine Perspective for Non-Convulsive Status Epilepticus Patients: Intravenous Midazolam

“…In a review by Maganti et al (8) on NCSE, they reported that IV benzodiazepines could be given as first-line therapy followed by IV phenytoin, phenobarbital, or valproic acid. Levatiracetam has become a commonly used agent for SE at emergency departments, particularly for pediatric patients (11). In a retrospective study conducted by Osorio et al (12), they found that the epileptiform waves of refractory SE patients who were administered IV 10 mg diazepam were suppressed on EEG.…”