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Query: UMLS:C0494475 (tonic-clonic seizure)
 1,319 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Nonconvulsive status epilepticus (NCSE) is common but often under-diagnosed. Due to the absence of specific symptoms, it is frequently misdiagnosed as a psychiatric disorder, which delays treatment. The cases of two patients who exhibited psychiatric symptoms and subtle cognitive disturbances (without confusion) as the sole manifestation of frontal lobe NCSE are reported. Both patients were initially treated as psychiatric disorders (depression and anorexia nervosa). The correct diagnosis was established by the electroencephalographic study, in one case after the patient experienced a generalized tonic-clonic seizure and in the other, after failure to improve with supposedly adequate treatment. There are reports of patients with NCSE whose symptoms suggest a psychiatric disorder (inappropriate behavior, emotional disinhibition, perseveration, reduced speech and motivation). This can occur without altered consciousness and symptoms may fluctuate, making the correct diagnosis extremely difficult. This entity can occur at any age and without a previous history of seizures. A high level of suspicion is necessary for prompt electroencephalographic study to confirm the diagnosis. Early treatment will correct the symptoms and significantly improve quality of life for patients and their families.
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PMID:Psychiatric disorders secondary to nonconvulsive status epilepticus of frontal origin. Two clinical case reports. 2272 34

Non-convulsive status epilepticus (NCSE) presents with minimal seizure activity clinically, but with evidence on EEG. It is a recognised cause of delirium in older people, but prevalence estimates vary widely. As delirium is a common presentation in older people and because NCSE is potentially reversible, an improved diagnostic ability in this group could be highly beneficial. EEG testing is required to make a definitive diagnosis, but this may be difficult due to access to testing, patient adherence and result interpretation. NCSE has two commonly recognised forms: complex partial status epilepticus (CPSE) and absence status epilepticus (ASE). Clinical features associated with NCSE in older people presenting with confusion include a reduction in level of arousal; aphasia or interrupted speech; myoclonus or subtle jerking; staring; automatisms; perseveration or echolalia; increased tone; nystagmus or eye deviation; emotional lability; disinhibition and anosagnosia. Risk factors include female sex, a history of epilepsy or a tonic-clonic seizure around the time of onset, and recent discontinuation of benzodiazepines. A practical approach to the diagnosis of NCSE in older people is suggested based upon the presence of clinical features suggestive of NCSE and local access to EEG testing.
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PMID:Non-convulsive status epilepticus: a practical approach to diagnosis in confused older people. 2639 67