Non-Convulsive Status Epilepticus

  • NCSE was originally described in patients with chronic epilepsy, but is now recognized with increased frequency in populations such as the critically ill
  • Similar to traditional classification of seizures, NCSE can be absence (as in this case), simple partial or complex partial
  • Some NCSE occur after a seizure where a patient remains confused and is confused for a prolonged post-ictal state
  • Up to 8 to 20% of comatose patients without seizure history will have EEG findings c/w NCSE when monitored
  • Risk factors for NCSE in critically ill: severe alteration of consciousness, hx of seizure, younger age, hx of brain injury, neurosurgical procedure, sepsis
  • Other risk factors for NCSE include medication non-adherence/discontinuation, drug withdrawal, structural brain injury or infection and metabolic derangements
  • Treatment: Unknown if treatment should be as aggressive as convulsive status, no RCT. Overall goal is to treat as well as sedate as minimally as possible to avoid inducing or prolonging coma and intubation
  • Treat with IV benzo and IV AED while monitoring with continuous EEG