Initial Treatment of Nonconvulsive Status Epilepticus

Abstract

Nonconvulsive status epilepticus (NCSE) encompasses a number of different entities including simple partial status epilepticus (SPSE) or aura continua, typical absence status epilepticus (ASE), complex partial status epilepticus (CPSE), and NCSE in coma. These conditions have different prognoses, and the seizure activity has a different effect on neuronal death and eventual morbidity, dependent upon the type of NCSE. The degree of impairment of consciousness and the underlying etiology probably have the greatest impact on prognosis. Prompt recognition of the condition is probably of most importance. ASE, SPSE and CPSE typically respond to oral or IV benzodiazepines (which should be used with caution in the critically ill elderly) and may also resolve with less sedating intravenous anti-seizure drugs. Anesthetic agents are rarely indicated and indeed should only be considered in select cases as the use of anesthetic agents may, in some instances, worsen prognosis. There is currently a state of equipoise on how NCSE in coma should be managed or indeed, how aggressive and persistent treatment should be in this condition.