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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Status epilepticus (SE) is a serious condition of prolonged or repetitive seizures. The annual incidence (86/100,000) of SE in the elderly who are aged 60 and greater is almost twice that of the general population and is even higher in those who are 70 years and older. Either acute or remote symptomatic stroke causes approximately 60% of SE seen in the elderly. SE is associated with a high mortality in the elderly (38%), with a rate approaching 50% in patients older than 80 years of age. Etiology is a strong determinant of mortality in the elderly: mortality approaches 100% in patients with anoxia and 30% in patients with either metabolic disorders, hemorrhages, tumors, or systemic infections. Mortality is almost three times higher in SE associated with acute ischemic stroke than in stroke alone, indicating synergistic effects. Duration of SE is also a factor in mortality. Treatment should be initiated for any convulsive seizure that lasts at least 10 min or is repetitive. An electroencephalogram (EEG) should be promptly obtained so that a diagnosis can be made without delay. Because older patients have a greater likelihood of nondiagnostic findings on routine EEGs, prolonged EEG recordings and inpatient video-EEG monitoring significantly increase the rate of establishing a definitive diagnosis. Nonconvulsive status epilepticus in the elderly is especially difficult to diagnose and should be evaluated with an EEG. Treatment of SE is complicated by altered pharmacokinetics in the elderly. Initial treatments, usually the administration of an intravenous benzodiazepine, have overall success rates of 55% for overt convulsive SE and 14.9% for subtle SE. For refractory SE, little is gained by using additional standard drugs, and general anesthesia with continuous EEG monitoring is recommended.
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PMID:Epidemiology and outcomes of status epilepticus in the elderly. 1743 20

We aimed to describe nonconvulsive status epilepticus in terms of patient age, etiology, initial presentation, and electroencephalogram and neuroimaging findings. Twenty children with nonconvulsive status epilepticus were identified by a retrospective review of children who underwent long-term electroencephalogram monitoring in a pediatric intensive care unit. Age ranged from 2 months to 18 years, and in 30% of patients, the age was <1 year. Nonconvulsive status epilepticus occurred most commonly in children with prior epilepsy (35%) or congenital heart disease (25%). Prior to nonconvulsive status epilepticus, most had experienced isolated seizures (55%) or convulsive status epilepticus (20%), but some had only preceding mental-status change (25%). The most common etiologies were exacerbation of epilepsy (35%) and ischemic stroke (25%). No children aged <1 year had preexisting epilepsy. Electroencephalograms confirmed nonconvulsive status epilepticus immediately in 65%. Nonconvulsive status epilepticus lasted up to 8 days, and neuroimaging was abnormal in 82% of patients. Nonconvulsive status epilepticus occurs in a heterogeneous group of children, results from acute symptomatic etiologies in children aged <1 year, most frequently follows isolated convulsions but can occur with only preceding mental status change, and is often prolonged. These findings suggest that a high level of suspicion for nonconvulsive status epilepticus must be maintained, and long-term electroencephalogram monitoring may be indicated in a large number of patients.
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PMID:Nonconvulsive status epilepticus in a pediatric intensive care unit. 1776 3

Seizure and epilepsy are common neurologic issues in cancer patients. Etiologies include structural abnormalities of the brain (eg, brain metastasis), cerebrovascular disease, reversible posterior leukoencephalopathy syndrome (RPLS), and radiation toxicity. Seizures associated with these etiologies often have focal features. Metabolic causes include hypoglycemia, electrolyte abnormalities, tumor lysis syndrome, thrombotic thrombocytopenic purpura (TTP), and medications used in cancer. A careful clinical evaluation can suggest the seizure etiology and guide subsequent work-up. Nonconvulsive status epilepticus should be suspected with persistent decreased level of consciousness following a seizure. Certain etiologies, such as RPLS and TTP, must be treated aggressively to minimize permanent neurologic injury. Routine prophylaxis with antiepileptic drugs (AEDs) is not recommended in patients with primary brain tumors or brain metastasis who have never had a seizure. Where indicated, the selection of AEDs should take into consideration side effects and interactions with chemotherapy. For this reason, non-enzyme-inducing AEDs are preferable in the cancer setting.
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PMID:Seizures and epilepsy in cancer: etiologies, evaluation, and management. 1836 62

We report a case of de novo absence status associated with focal discharge and polydipsia-induced hyponatremia. Nonconvulsive status epilepticus (NCSE) is classified as absence status or complex partial status. Absence status is characterized by bilateral synchronized spike and wave complex bursts and a variety of conscious disturbances. Possible precipitating factors for NCSE include benzodiazepine withdrawal, excessive use of psychotropic drugs, and electrolyte imbalances. Hyponatremia is a rare precipitating factor. In this case, the patient was 59 years old and had suffered from primary insomnia but had no history of epilepsy. NCSE improved by means of saline infusion. However after recovery from NCSE EEG revealed some spikes in the left frontal area. Absence seizures can also show generalized spike and slow waves, and cases of focal lesion-associated absence seizures have been reported. Although absence seizures and absence status are two distinct conditions, they should not be considered together. We assumed that hyponatremia induced by polydipsia precipitated epileptogenicity in the left frontal area, and then focal activity secondarily generalized and resulted in absence status.
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PMID:Absence status associated with focal activity and polydipsia-induced hyponatremia. 1872 38

Nonconvulsive status epilepticus (NCSE) is a medical emergency, which is diagnosed most frequently with the routine use of EEG in the pediatric emergency and intensive care units. Data from eight patients, ranging from 2.8-15 years old (median 8.7 years), treated with the diagnosis of NCSE were evaluated on clinical basis. The patients attended the hospital with acute confusional state ranging from sudden onset of verbal cooperation insufficiency to aimless-meaningless behavior and confusion without any motor component of seizure. While five of the cases were diagnosed and followed up with epilepsy, the other three had no history of epilepsy. No reason was detected that could cause acute encephalopathy. EEG examinations during acute confusional state showed partial or generalized continuous electrographic seizure activity lasting at least 30 minutes without clinical seizure activity. After administration of intravenous antiepileptic medication, the confusional states of the patients recovered, and the EEG examinations showed normal baseline activity with significantly diminished discharges or complete normal waveform. Nonconvulsive status epilepticus should be considered in all children admitted to the hospital with acute unexplained encephalopathy, whether they have a history of epilepsy or not. Emergent EEG examination should be a routine part of evaluation in these children for the diagnosis and treatment of NCSE.
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PMID:Nonconvulsive status epilepticus during childhood: clinical and electroencephalographic features. 1910 49

Nonconvulsive status epilepticus can manifest as personality changes and psychosis. We report an 87-year-old right-handed male presenting with both Capgras syndrome and severe unilateral spatial neglect during nonconvulsive status epilepticus. After treatment of his seizures, his Capgras syndrome and hemispatial neglect resolved. This case illustrates a report of the confluence of Capgras syndrome and documented hemispatial neglect in nonconvulsive status epilepticus only reported once previously [1].
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PMID:Capgras syndrome and unilateral spatial neglect in nonconvulsive status epilepticus. 1949 75

Nonconvulsive status epilepticus (NCSE) can occur in comatose patients without clinical signs of seizure activity. We evaluated the occurrence of NCSE in patients who were admitted to our neurosurgical intensive care unit between 1998 and 2000. EEGs were obtained from 158 patients with head trauma, spontaneous bleeding or brain tumour. Patients with clinically apparent seizure activity or no electrophysiological signs of seizure activity were excluded from the study. Epileptiform activity was seen in 28 out of 158 patients. 11/28 of these patients had a Glasgow-Coma-Scale (GCS) Score below 9 and showed continuous epileptiform discharge without clinical signs of seizure activity (NCSE). The clinical status of 4 of these 11 NCSE patients improved after initiation of anticonvulsive medication. NCSE may be an under-recognised cause of coma in neurosurgical intensive medicine. EEG should be included in the routine evaluation of comatose patients, even if clinical seizure activity is not apparent.
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PMID:Nonconvulsive status epilepticus as a possible cause of coma in neurosurgical intensive care. 1985 57

Nonconvulsive status epilepticus (NCSE) is a serious condition commonly considered when evaluating a patient with altered mental status, and an electroencephalogram (EEG) is necessary for diagnosis. Neurology house staff often must make this diagnosis at times when no EEG technologist is available. We report our experience with abbreviated, emergency below-the-hairline EEGs (BTH-EEG) performed by neurology residents at our institution over a 1-1/2 year period. We analyzed demographic and clinical data in relation to whether or not an ictal or periodic pattem was identified, and these results were compared to follow up EEGs. Thirty-nine studies were identified, ranging in duration from 3 min-13 hrs. Mean and median age of patients included was 53 (range 25-81 yrs); 21 were female. Seven of 39 BTH-EEGs showed at least one electrographic seizure, 9 more showed periodic discharges. Follow-up EEGs showed electrographic seizures in 6 of 39 patients, including 3 of the 7 with ictal BTH-EEG, and an additional 3 whose BTH-EEGs showed periodic lateralized discharges but no organized seizures. All 7 patients with ictal BTH-EEGs survived to discharge, vs. 23 of the remaining 32. We conclude that in selected cases, BTH-EEG is useful in detecting seizures and/or other epileptiform patterns. In our series, when NCSE was in question, the BTH-EEG showed these patterns 41% of the time. The BTH-EEG is a fast, non-invasive, inexpensive tool that may save valuable time, especially when no other viable option is immediately available. This technique may be applicable more broadly, not just limited to centers with neurology residents.
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PMID:Utilization of below-the-hairline EEG in detecting subclinical seizures. 2030 11

Nonconvulsive status epilepticus (NCSE) is defined by cognitive or behavioural changes for at least 30 minutes supplemented with evidence of seizures on electroencephalogram (EEG). NCSE constitutes 25% of all cases of status epilepticus (SE) and the highest incidence is seen among children below one year of age. The condition frequently occurs in patients with neurological injuries, specific epilepsy syndromes, learning disabilities and in the course of convulsive SE. Aggressive treatment is recommended for complex partial NCSE and in comatose patients and cautious treatment is recommended in absence and simple partial NCSE.
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PMID:[Nonconvulsive status epilepticus in children]. 2082 36

Nonconvulsive status epilepticus (NCSE) refers to a prolonged seizure that manifests primarily as altered mental status as opposed to the dramatic convulsions seen in generalized tonic-clonic status epilepticus. There are 2 main types of NCSE, each of which has a different presentation, cause, and expected outcome. In the first type of NCSE, patients present with confusion or abnormal behavior, suggesting the diagnosis of absence status epilepticus (ASE) or complex partial status epilepticus (CPSE). The second type of NCSE (subtle status epilepticus [SSE]) must be considered in comatose patients who present after a prolonged generalized tonic-clonic seizure and who may have only subtle motor manifestations of a seizure, such as facial or hand twitchings. Whereas the morbidity and mortality in patients with prolonged ASE or CPSE is low, the mortality associated with SSE can exceed 30% if the seizure duration is greater than 60 minutes.
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PMID:Nonconvulsive status epilepticus. 2110 3


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