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Epidemiology, diagnosis, and management of nonconvulsive status epilepticus: Opening Pandora's box
Raoul Sutter1, Stephan Rüegg1, Peter W Kaplan1
1Division of Neuroscience Critical Care, Department of Anesthesiology and Critical Care Medicine (RS), Department of Neurology (RS, PWK), and Department of Neurosurgery (RS), Johns Hopkins University School of Medicine, Baltimore; Department of Neurology (RS, PWK), Johns Hopkins Bayview Medical Center, Baltimore, MD; and Division of Clinical Neurophysiology (RS, SR), Department of Neurology, University Hospital Basel, Switzerland.
Abstract:
Nonconvulsive status epilepticus (NCSE) is a state of continuous seizure activity for at least 30 minutes, with cognitive or behavioral changes. It may be classified according to EEG evidence of focal or generalized epileptic activity, but may be further categorized by etiology and level of consciousness, both with prognostic weight. There have been several attempts to define the electrographic characteristics of NCSE. Clinical challenges arise from the frequent subtle clinical manifestations, the need for EEG confirmation of ongoing epileptic activity, and physicians' lack of awareness of the possibility of NCSE. This underdiagnosis may have deleterious consequences. This review encompasses epidemiologic, clinical, diagnostic, and prognostic aspects of NCSE in adults, and delineates strategies for management.