Diagnosis, Etiology, and Treatment of Nonconvulsive Status Epilepticus, a Semiological Oriented Review.

Abstract

Nonconvulsive status epilepticus (NCSE) defines a prolonged electrographic seizure activity resulting in nonconvulsive symptoms. Semiology is a crucial element in diagnosis, etiological evaluation, and treatment plan of NCSE. It includes mostly generalized myoclonic status (GMS), focal simple motor status (FSMS), and dyscognitive status (DS). This review aims to guide clinicians in diagnosis, etiological evaluation, and treatment of patients with NCSE based on semiological presentation. Diagnosis of GMS and FSMS is based mainly on semiology, whereas DS often requires EEG for differential diagnosis with nonepileptic events. GMS and FSMS etiological investigation may be readily prioritized based on semiological type, whereas DS requires EEG for further classification in psychomotor status and absence status. Choice of appropriate treatment is dictated by the semiological presentation, EEG findings, and etiology. Surgery and other interventions including electroconvulsive therapy and vagal nerve stimulation should be considered in patients refractory to medical treatment.