Nonconvulsive status epilepticus: overlooked and undertreated

Nonconvulsive status epilepticus (NCSE) is characterized by persistent change in mental status from baseline lasting more than 5 minutes, generally with epileptiform activity seen on EEG monitoring and subtle or no motor abnormalities. NCSE can be a difficult diagnosis to make in the emergency department setting, but the key to diagnosis is a high index of suspicion coupled with rapid initiation of continuous EEG and early involvement of neurology. Benzodiazepines are the mainstay of first-line therapy, with antiepileptic drugs and anesthetics as second- and third-line therapies, respectively. The few established guidelines on the treatment of NCSE are highly variable, and the objective of this comprehensive review is to create a standardized evidence-based protocol for the diagnosis and treatment of NCSE.