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Query: UMLS:C0038220 (status epilepticus)
 7,272 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Nonconvulsive status epilepticus in intensive care units (ICUs) is common and increases the risk of death. Nonconvulsive status epilepticus treatment delays are associated with poor patient outcomes. Continuous EEG or EEG-video monitoring is used in ICU settings to diagnose subtle seizures and nonconvulsive status epilepticus among at-risk populations including patients with closed head injuries and altered consciousness, stroke, subarachnoid hemorrhage, neonates at-risk for sepsis or hypoxic-ischemic encephalopathy, and children who have undergone surgery for congenital heart disease. However expert EEG interpretation, currently required for accurate diagnosis, often lags behind the real-time recordings by hours or even longer. At most hospitals the numbers of at-risk patients in intensive care units far exceeds the capacity of the available EEG equipment and personnel to perform and interpret EEGs. Seizure-detection software, compressed EEG spectral arrays, and near real-time remote EEG interpretation have brought us closer to the goal of real-time analysis of EEG for intensive care decisions, but even at major tertiary referral centers the vast majority of at-risk ICU patients do not undergo EEG monitoring. Additional technological advances, innovative use of EEG technologists and ICU personnel, and clinical trials of new EEG monitoring technology and associated clinical outcomes are needed to achieve the goal of optimal use of EEG data for intensive care decisions.
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PMID:Ellen R. Grass Lecture: Rapid EEG analysis for intensive care decisions in status epilepticus. 1660 69

Nonconvulsive status epilepticus is characterized by continuous or near continuous epileptiform discharges on electroencephalography without overt motor or sensory phenomena. It is a symptomatic condition related to a disease such as epileptic encephalopathy or a metabolic disorder. Children with isolated nonconvulsive status epilepticus rarely present with global neurodevelopmental delay. This report describes an 18-month-old male who presented with global neurodevelopmental delay and decreased alertness in whom electrical status epilepticus during sleep, which is a form of nonconvulsive status epilepticus, was determined. Metabolic investigations and cranial magnetic resonance imaging were normal. He began to achieve developmental milestones after treatment with valproic acid. Although rare, pediatric neurologists and pediatricians must be aware of this condition in making the differential diagnosis of global neurodevelopmental delay and decreased alertness.
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PMID:Nonconvulsive status epilepticus and neurodevelopmental delay. 1693 62

Nonconvulsive status epilepticus can present with several manifestations, many of which might not be obvious. The most important for the diagnosis of nonconvulsive status epilepticus is the electroencephalogram (EEG) pattern. This is a case report of a 9-year-old boy with severe and continuous headache. He received chemotherapy for histiocytosis and was diagnosed at 3.5 years. He had no evidence of central nervous system histiocytosis involvement or drug toxicity. He was diagnosed with nonconvulsive status epilepticus. Headache and EEG anomaly disappeared completely when anticonvulsant therapy was begun. Headache and seizure disorder can coexist, but this might be the first report of nonconvulsive status epilepticus with headache as a sole manifestation.
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PMID:Headache as a sole manifestation in nonconvulsive status epilepticus. 1709 68

A 6-year-old male with cortical dysplasia who developed secondarily generalized nonconvulsive status epilepticus is reported. He had partial epilepsy since the age of 10 months. On electroencephalography, almost continuous left frontocentral/anterior temporal spikes were observed at 3 years of age, which lasted until 6 years of age, when he developed nonconvulsive status epilepticus. Nonconvulsive status epilepticus lasted for more than 7 days. Electroencephalography during nonconvulsive status epilepticus documented almost continuous generalized polyspike-wave complexes suggestive of generalized nonconvulsive status epilepticus. On magnetic resonance imaging, abnormal gyration was observed in the left frontal lobe. Histopathologic analysis of the resected left frontal lobe revealed cortical dysplasia. The present case demonstrates that continuous focal epileptiform discharges caused by cortical dysplasia in the frontal lobe can develop into secondarily generalized nonconvulsive status epilepticus.
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PMID:Generalized nonconvulsive status epilepticus in symptomatic partial epilepsy. 1735 57

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

Nonconvulsive status epilepticus (NCSE) is relatively common; it comprises at least one third of all cases of status epilepticus. NCSE may be an even more common, yet more elusive, condition in the elderly population. NCSE can be divided into complex partial status epilepticus (CPSE), NCSE in coma, and typical absence status epilepticus (TAS). The clinical manifestations may be subtle, and thus the diagnosis of these conditions is critically dependent on electroencephalography (EEG). When EEG demonstrates typical ictal patterns, the diagnosis is usually straightforward. However, in many circumstances the EEG pattern has to be differentiated from other encephalopathic patterns, and this differentiation can prove troublesome; clinical and electrographic response to treatment can prove helpful in these situations. The prognosis for NCSE in the elderly is generally poor due to the underlying etiology rather than the persistence of electrographic discharges. Whether the neuronal damage that occurs in convulsive status epilepticus and in animal models of limbic status epilepticus also occurs in NCSE in humans is still a matter of debate. Intravenous treatment is not benign, especially in the elderly, who may be at greater risk of systemic complications from hypotensive and sedative agents. Therefore, a more conservative approach to the treatment of NCSE in the elderly is warranted. Oral benzodiazepines should be used for the treatment of TAS and CPSE in noncomatose patients with a prior history of epilepsy, and in some circumstances, intravenous medication may be necessary. Generally, anesthetic coma should not be advised in either of these conditions. A more aggressive approach may be required with NCSE in coma, in the hope of improving a very poor prognosis. Treatment regimens will remain largely speculative until there are more relevant animal models and controlled trials of conservative versus aggressive treatment.
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PMID:Treatment of nonconvulsive status epilepticus. 1743 32

This case report presents the epileptic encephalopathy in an 11-year-old girl with multilobar unilateral polymicrogyria and focal nonconvulsive status epilepticus where high epileptogenicity was responsible for progressive and severe cognitive dysfunction. Nonconvulsive status epilepticus in epileptic encephalopathy with unilateral multilobar polymicrogyria has not been reported previously.
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PMID:Electroencephalogram in unilateral multilobar polymicrogyria with nonconvulsive status epilepticus. 1762 37

Nonconvulsive status epilepticus may present with several manifestations, and many of them may not be obvious. The most important for the diagnosis of nonconvulsive status epilepticus is the electroencephalogram pattern. This is a case report of a 9-year-old boy with severe and continuous headache. He received chemotherapy for histiocytosis that was diagnosed when he was 3 years, 6 months years old. He had no evidence of central nervous system histiocytosis involvement or drug toxicity. He was diagnosed with nonconvulsive status epilepticus. The headache and electroencephalogram anomaly disappeared completely when anticonvulsant therapy began. Headache and seizure disorder may coexist, but this may be the first report of nonconvulsive status epilepticus with headache as a sole manifestation.
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PMID:Headache as a sole manifestation in nonconvulsive status epilepticus. 1769 80

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

Nonconvulsive status epilepticus (NCSE) encompasses a wide range of diagnoses with variable outcomes and treatment recommendations. In children, NCSE can be observed in various conditions, including acute neurological injuries, specific childhood epilepsy syndromes and other neurological conditions, and can also be observed in individuals with learning difficulties. NCSE in children is thought to be under-recognized, and further studies examining the electrographic characteristics of very young children in NCSE would aid the prompt recognition of additional patients. Some subtypes of NCSE are probably more harmful than others, and long-term prospective studies are needed to evaluate the damaging potential of NCSE itself as opposed to that of the underlying circumstances in which it occurs. Specific data in childhood are clearly lacking, but extrapolation from adult studies indicates that aggressive treatment is most warranted in comatose patients. By contrast, a cautious approach seems to be indicated for absence status epilepticus, complex partial status epilepticus and electrical status epilepticus during sleep.
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PMID:Diagnosis and management of nonconvulsive status epilepticus in children. 1780 45


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