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The Management of Nonconvulsive Status Epilepticus in Adults

  • Suzette M. LaRoche
  • Hiba A. Haider
Chapter
Part of the Current Clinical Neurology book series (CCNEU)

Abstract

Nonconvulsive status epilepticus (NCSE) is a common condition with various clinical presentations and a wide range of etiologies and outcomes. NCSE has traditionally been defined as a condition of intermittent or ongoing seizure activity without convulsions for at least 30 min with no recovery between attacks. More recently, however, experts have recommended shortening the minimum duration of seizure activity to 5–10 min for meeting NCSE criteria. NCSE most commonly occurs after generalized continuous status epilepticus. Therefore, patients without return to baseline after cessation of clinical seizure activity should be evaluated with continuous electroencephalogram monitoring. NCSE is also common in comatose patients with acute brain injury and should be suspected in patients with abrupt behavioral change or fluctuating level of consciousness. The prognosis of NCSE ranges from relatively benign to fatal and is mainly dependent on the underlying etiology and the patient’s age. Lack of randomized trials has meant that NCSE treatment recommendations rely on extrapolation from the existing literature on convulsive status epilepticus. Management should include abortive therapy with benzodiazepines and concurrent loading of a non-sedating anti-seizure drug (ASD) (such as phenytoin/fosphenytoin, valproate, lacosamide, or levetiracetam), and if seizures continue, sedative-anesthetics or a second non-sedating ASD. Careful consideration of the prognosis of the patient is paramount because aggressive treatment with anesthetic medications and prolonged ICU stays are both associated with significant medical complications. On the other hand, ongoing NCSE has been associated with secondary neurologic injury and worsened outcomes. Therefore, it is important to individualize treatment by weighing the risks of treatment against the expected outcome on a case-by-case basis.

Keywords

Nonconvulsive status epilepticus Electrographic status epilepticus Continuous EEG Monitoring Intensive care Ictal–interictal continuum 

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Copyright information

© Springer Science+Business Media LLC 2018

Authors and Affiliations

  1. 1.Department of Neurology, Mission Health SystemEmory University School of MedicineAshevilleUSA
  2. 2.Division of EpilepsyEmory University School of MedicineAtlantaUSA

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