Overreliance on EEG normalization: a case report of DEE-SWAS treated as presumed NCSE leading to avoidable escalation

A 10-year-old boy with a 6-year history of recurrent seizures and cognitive decline was diagnosed with developmental and epileptic encephalopathy with spike-and-wave activation in sleep (DEE-SWAS). Previous treatments involving multiple anti-seizure medications and repeated high-dose methylprednisolone only provided temporary efficacy. Three weeks ago, he was misdiagnosed with non-convulsive status epilepticus (NCSE) at another hospital due to electrical status epilepticus during sleep (ESES) on electroencephalography (EEG). He was then put into an anesthesia-induced coma in order to convert the EEG to burst-suppression. However, this intervention resulted in severe complications, including ventilator-associated pneumonia. Discontinuing the anesthetics and sedatives, and adjusting his antiepileptic treatment regimens promoted his recovery. Although his seizures resolved, the ESES persisted on EEG. Furthermore, the prolonged induced coma impaired his neurological function, and the stay in intensive care unit imposed a significant medical burden. This case cautions carefully differentiating between ESES and NCSE, and against overreliance on EEG "normalization" without a rigorous risk-benefit assessment of anesthesia-induced coma.