Non-Convulsive Status Epilepticus in Emergency Department: A Diagnostic Challenge

Abstract

Non-convulsive status epilepticus had always been a diagnostic dilemma to emergency physicians. The challenge falls in its elusive nature and the subtlety of physical findings. Understanding the essence this disease process and the approach to it will result into a rewarding outcome for the patient and the physician. In this brief review we are trying to shed some light on that ambiguous neurological emergency and try to come up with a facilitated way of dealing with this common source of morbidity and mortality. Discussion Non-convulsive status epilepticus (NCSE) is a term used to refer to a prolonged seizure without an overt motor signs. It’s also defined as an altered mental status or change in the behavior from baseline with continuous epileptiform EEG changes. A review of literature showed that till now there is no acceptable definition. [1] NCSE are thought to be responsible for about 25% of the status epilepitcus. [2] De Lorenzo et al conducted a retrospective study in which 164 patients were subjected to a continuous 24 hours EEG monitoring after seizure treatment. He found that 14% of the patients had a NCSE and about 48% of the patient had a persistent seizure activity on EEG. [3] Treiman et al also in a similar manner found that 25% of the patient had NCSE after treatment for GCSE when monitored by EEG in his study that included 384 patients. [23] NCSE diagnosis has always been a diagnostic challenge to emergency physicians as there are no definitive diagnostic criteria, and due to the hectic nature of the emergency department its sound to difficult to do full neurological exam and in-depth medical history. [4] NCSE encompasses a group of syndromes that varies from self-limiting to refractory form. Absence SE and partial complex SE are the 2 major types that are commonly known although some recent data from medical literature had shown other subtypes. Clinical suspicion and EEG findings are mainstay to establish the diagnosis. Clinically, high index of suspicions should be kept in cases of: [5]  Prolonged postictal states  Absence of other clinical explanation for the patients with altered mental status  Stroke patients that seemed worse than expected  Subtle signs (blinking, twitching, fluctuating sensorium. Etc.). www.jmscr.igmpublication.org Impact Factor 5.244 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: http://dx.doi.org/10.18535/jmscr/v4i8.103