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Generalized Periodic Discharges: Nonconvulsive Status Epilepticus or Diffuse Encephalopathy-A Case Comparison
Chanawee Hirunpattarasilp1,2, Joshua Edmondson1,3, Daniel Wood1,4
1Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A.
Nonconvulsive status epilepticus (NCSE) presents differently in comatose versus non-comatose patients. Coma in NCSE may not stem from epileptiform discharges, unlike the responsive state in non-comatose NCSE.
Area of Science:
- Neurology
- Clinical Neurophysiology
Background:
- Nonconvulsive status epilepticus (NCSE) is defined by persistent epileptiform discharges on electroencephalogram (EEG) meeting Salzburg criteria.
- NCSE manifests with varying levels of consciousness, including coma and dialepsis (unresponsiveness with amnesia).
Purpose of the Study:
- To describe a case of NCSE with coma induced by ceftriaxone neurotoxicity.
- To compare the electroclinical features of NCSE with coma to NCSE without coma in a patient with chronic epilepsy.
Main Methods:
- Case report analysis.
- EEG monitoring and electroclinical correlation.
Main Results:
- Generalized periodic discharges (GPDs) in NCSE with coma might be epiphenomenal, not directly causing coma.
- The dialeptic state in NCSE without coma is a direct result of epileptiform discharges, requiring treatment.
Conclusions:
- NCSE with coma and NCSE without coma have distinct underlying mechanisms and clinical presentations.
- Ceftriaxone can induce NCSE with coma, highlighting the importance of neurotoxicity assessment in critically ill patients.
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