[Non-convulsive status epilepticus--confusion and cognitive failure during seizures]

Non-convulsive status epilepticus is characterized by confusion and impaired consciousness, lasting at least half an hour. Seizure activity in the EEG confirms the diagnosis, but ictal discharges can be heterogeneous and difficult to classify. There is controversy regarding evidence of morbidity in humans.

We report three patients with non-convulsive status epilepticus.

In two patients, the clinical findings during seizures were subtle cognitive impairment. One patient was confused during seizures. Localisation of seizure activity in the EEG was mainly frontal in two patients, and generalised with focal predominance in one. There were no sign of neurologic sequelae after the seizures were terminated.

Complex partial status epilepticus of frontal origin is common, but differentiation between complex partial and generalised non-convulsive status can be difficult. The clinical symptoms may overlap, and generalised EEG seizure activity does not exclude initial focal ictal discharges. Presumably the reported sequelae after this condition are in most cases a consequence of underlying cerebral illness. Treatment response to diazepam can be variable, with high recurrence risk. Effective prophylactic treatment is most important.