Nonconvulsive status epilepticus: clinical features and diagnostic challenges

NCSE, once thought to be a rare disorder, should be considered in any patient presenting with an alteration in mental status of indeterminate cause. The psychiatrist needs to be aware of the different clinical characteristics of this disorder as well as similarities and differences from psychiatric disorders. A history of seizure is not necessary for the diagnosis, nor is motor activity necessarily associated with NCSE. An EEG is required to confirm the diagnosis and should be performed when possible, because early recognition and treatment may improve outcome. There is usually a good response to an intravenous benzodiazepine; when response has been delayed, other anticonvulsants have been used as adjuncts. The EEG is necessary to distinguish AS from CPS so that, when indicated, the proper long-term antiepileptic drug therapy can be started. Although NCSE has been described in the literature for many years, there is still a great need for carefully designed prospective studies to help define clear guidelines to assist in clinical and management decision making and, ultimately, to improve outcomes.