Case Of Nonconvulsive Status Epilepticus Research Articles

The therapeutic effect of vagus nerve stimulation on super-refractory nonconvulsive status epilepticus

Super refractory status epilepticus (SRSE) is a condition in which status epilepticus persists despite 48 hours of anesthetic treatment. Nonconvulsive status epilepticus (NCSE) is characterized by seizures lasting more than 30 min on an electroencephalogram, with accompanying changes in behavior or consciousness without convulsions. Prompt treatment of NCSE is crucial, as delayed treatment may lead to additional brain damage and progression to convulsive status epilepticus. Although vagus nerve stimulation (VNS) has been approved as an adjunct treatment for drug-resistant epilepsy, it is rarely used to treat refractory status epilepticus. To the best of our knowledge, only two cases of NCSE treated with VNS have been reported to date, and these patients were successfully treated with VNS for NCSE caused by anti-NMDAR encephalitis. We report the case of a patient with posttraumatic epilepsy who developed super refractory-NCSE after convulsive status epilepticus and was successfully treated with VNS.

Non-Convulsive Status Epilepticus as a Manifestation of Methotrexate-Induced Leukoencephalopathy

Methotrexate (MTX) is an anti-metabolite used in the treatment of leukemia and autoimmune disease. Careful observation of MTX concentration should be performed as side effects such as seizure, headache, limb paralysis, and confusion are found in MTX-induced leukoencephalopathy. To our knowledge, there was no reported case of non-convulsive status epilepticus as a manifestation of MTX-induced leukoencephalopathy in South Korea. Here, we report a 54-year-old patient that was diagnosed with non-convulsive status epilepticus after long-term use of MTX.

Analysis of electroclinical features of nonconvulsive status epilepticus: a study of four cases

BackgroundThe nonconvulsive status epilepticus (NCSE) is an epileptic condition characterized by little or no obvious symptoms, thus is often easily to be underrecognized, underdiagnosed or even undetected by clinicians. This article is written to advance the recognition and diagnosis of NCSE.Case presentationFour cases of NCSE were reported and their semiology, electroencephalogram (EEG) features, etiology, treatment and prognosis were retrospectively analyzed. Most of the 4 cases presented with impaired consciousness (confused, slow reaction and lags in response) and some strange behaviors (being upset and restless or washing hands repeatedly). None of them had any obvious motor symptoms like tonic or clonic movements. EEG of the 4 cases initially manifested with either a focal or a generalized onset, then evolved into spike-and-wave pattern gradually. With a favorable response to antiepileptic drugs, they all had a good outcome without any sequela.ConclusionsNCSE is much more common than was considered in the past, which is featured by little or no evidence of movement or other symptoms. NCSE can lead to a favorable outcome in most patients.

Non-convulsive status epilepticus induced by acute thalamic lesions: A report of three cases

The thalamocortical network appears to play a pivotal role in ictogenesis. We herein present three cases of non-convulsive status epilepticus (SE), in adult patients without previous history of epilepsy or seizures, precipitated by acute thalamic vascular and metabolic-induced lesions. In all cases the EEG showed patterns consistent with generalized SE confirmed either by a fast and complete clinical and EEG response to anti-seizure medication or definitive subtle motor signs consistent with SE. We argue that the subcortical disruption of thalamocortical networks due to the thalamic lesion predisposed to the occurrence of non-convulsive SE. In patients with thalamic disorders and unexplained mental status changes EEG evaluation should always be considered.

Clinical Electroencephalography Findings and Considerations in Hospitalized Patients With Coronavirus SARS-CoV-2.

Reports have suggested that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes neurologic manifestations including encephalopathy and seizures. However, there has been relatively limited electrophysiology data to contextualize these specific concerns and to understand their associated clinical factors. Our objective was to identify EEG abnormalities present in patients with SARS-CoV-2, and to determine whether they reflect new or preexisting brain pathology. We studied a consecutive series of hospitalized patients with SARS-CoV-2 who received an EEG, obtained using tailored safety protocols. Data from EEG reports and clinical records were analyzed to identify EEG abnormalities and possible clinical associations, including neurologic symptoms, new or preexisting brain pathology, and sedation practices. We identified 37 patients with SARS-CoV-2 who underwent EEG, of whom 14 had epileptiform findings (38%). Patients with epileptiform findings were more likely to have preexisting brain pathology (6/14, 43%) than patients without epileptiform findings (2/23, 9%; p = 0.042). There were no clear differences in rates of acute brain pathology. One case of nonconvulsive status epilepticus was captured, but was not clearly a direct consequence of SARS-CoV-2. Abnormalities of background rhythms were common, as may be seen in systemic illness, and in part associated with recent sedation (p = 0.022). Epileptiform abnormalities were common in patients with SARS-CoV-2 referred for EEG, but particularly in the context of preexisting brain pathology and sedation. These findings suggest that neurologic manifestations during SARS-CoV-2 infection may not solely relate to the infection itself, but rather may also reflect patients' broader, preexisting neurologic vulnerabilities.

Clinical presentation, epidemiology, neurophysiological findings, treatment and outcome of nonconvulsive status epilepticus: a 3-year prospective, hospital-based study

Objective: This study reports the prevalence of Nonconvulsive Status Epilepticus (NCSE) in patients with altered mental status (AMS), and describes the clinical presentation, etiology, neurophysiological findings, neuroimaging, treatment, and outcome of NCSE in Qatar. Recording duration of continuous EEG monitoring was also discussed.Methods: This was a 3-year, prospective, hospital-based study involving patients with AMS and continuous EEG monitoring admitted to the Emergency and ICUs of Hamad Hospital, Qatar. Patients with confirmed diagnosis of NCSE were compared to the patients who did not show EEG and clinical features compatible with NCSE. Descriptive statistics in terms of mean with standard deviation, as well as frequency and percentages for categorical variables, were calculated; Student’s t test as well as Chi-square tests or Fisher’s exact tests were applied. Logistic regressions NSCE was performed using significance level 0.05 for independent variables at univariate analysis.Results: Number of patients with AMS and continuous EEG monitoring was 250. Number of patients with EEG compatible with NCSE: 65 (age range, 12–79 ys; m, 37; f, 28). Number of controls (defined as patients with EEG not compatible with NCSE): 185 (age range, 12–80 ys; m, 101; f, 84). Rate of occurrence of NCSE in patients with AMS: 26%. NCSE group was younger than controls (p < .001). Twenty patients with NCSE (31%) and 35 patients in the control group (19%) died. Death was more frequent in comatose NCSE compared to controls (p < .0007). NCSE proper and comatose NCSE had longer hospital stays than controls (p < .02 and p < .03, respectively). Complete recovery occurred in 26 NCSE patients (40%) and in 98 controls (53%) (p < .08). Twenty-one patients (31%) presented with refractory NCSE: 12 patients survived, 9 died.Conclusion: This was the first prospective study reporting a high number of NCSE in Qatar, a small country in the MENA region. This prevalence (26%) was in the middle range. NCSE patients did not perform better than controls, outcome being worse with comatose NCSE. NCSE is an emergent condition warranting expedited diagnosis and management. Three days of continuous EEG monitoring were able to diagnose most cases of NCSE.

意識障害を主徴とした非けいれん性てんかん重積状態（NCSE）の高齢者2症例の検討

意識障害を主徴とした非けいれん性てんかん重積状態（NCSE）の高齢者2症例の検討

成人心臓血管外科術後の非痙攣性てんかん重積状態11症例の検討

成人心臓血管外科術後の非痙攣性てんかん重積状態11症例の検討

Nonconvulsive status epilepticus in the elderly associated with newer antidepressants used at therapeutic doses: A report of three cases.

Classic antidepressants have been known to induce convulsive seizures and nonconvulsive status epilepticus (NCSE). On the other hand, many reports have emphasized the safety of novel antidepressants. However, we encountered three cases of NCSE in the elderly associated with the use of newer antidepressants at therapeutic doses.All three patients were male and were 73 years of age or older. One patient was recently diagnosed with temporal lobe epilepsy and treated with low-dose lamotrigine. In all patients, newer antidepressants were initiated because of depressive symptoms. After titrating to therapeutic doses (paroxetine 20 mg/day, sertraline 50 mg/day, and combination of sertraline 50 mg/day and mirtazapine 30 mg/day in one patient each), impaired consciousness appeared. Electroencephalography (EEG) showed generalized slow waves with intermittent spike–slow-wave complexes. Intravenous injection of antiepileptic drugs improved EEG findings and clinical symptoms. After discontinuance of the abovementioned antidepressants, NCSE did not recur in any of patients. These reports raise the question of whether the newer antidepressants, like classic antidepressants, might also induce NCSE in the elderly, even when used at therapeutic doses. Physicians should consider monitoring for possible NCSE when using newer antidepressants in patients who may have low drug tolerability. Active continuous video-EEG monitoring is essential when behavioral and psychological symptoms or change in consciousness level is suspected.

Levetiracetam improves disinhibitory behavior in nonconvulsive status epilepticus.

BackgroundNonconvulsive status epilepticus (NCSE) is a severe medical condition and heterogeneous disorder defined by different seizure types and diverse etiologies. NCSE occurs commonly in the elderly and is potentially misdiagnosed as a psychiatric disorder. Current treatment options for NCSE are still unsatisfactory.Case presentationWe report a case of NCSE in a 55-year-old epileptic male patient with a history of infectious encephalitis, disinhibitory behavior, and a suspected diagnosis of frontotemporal dementia. Add-on levetiracetam (LEV) to carbamazepine treatment improved clinical manifestations and abnormal electroencephalographic discharge.ConclusionWith disinhibitory behavior in the elderly, the possibility of NCSE should be considered. Moreover, LEV may be an effective and well-tolerated pharmacotherapy for elderly NCSE patients.

Nonconvulsive status epilepticus manifesting as full-blown psychosis during pregnancy

Nonconvulsive status epilepticus (NCSE) can produce a wide spectrum of clinical symptoms depending on the regions and the relative amount of brain that is made dysfunctional by persistent epileptic discharges. NCSE can cause ictal behaviors resembling psychosis. However, only a few clear cases of NCSE causing diverse features of psychosis have been reported. We describe a patient with NCSE during pregnancy, who demonstrated full-blown psychotic symptoms associated with right hemispheric ictal activity on EEG.

A case of nonconvulsive status epilepticus presenting as dissociative fugue

&lt;p&gt;&lt;span&gt;Nonconvulsive status epilepticus is characterised by changes in behaviour, memory, affect or level of consciousness. We report a case of nonconvulsive status epilepticus precipitated by carbamazepine that presented as dissociative fugue. The patient was a 49-year-old man. He first experienced a tonic-clonic seizure nine years previously and was diagnosed with &lt;em&gt;grand mal&lt;/em&gt; epilepsy. He had been using carbamazepine 800 mg daily for the last eight years. He had not had any tonic-clonic seizures since carbamazepine was introduced but began to display behavioural disturbances periodically. He also left home many times, and remembered nothing about the period he had been away after he returned. He was hospitalised with a preliminary diagnosis of dissociative fugue. He had recurrent episodes with dissociative symptoms during his stay in the hospital. An electroencephalogram (EEG) and a 24-hour video EEG revealed nothing abnormal. An EEG recording taken during an episode indicated complex partial status epilepticus. Carbamazepine was substituted with valproate, and the patient was discharged in remission. &lt;/span&gt;&lt;/p&gt;

A case of nonconvulsive status epilepticus presenting as dissociative fugue

Nonconvulsive status epilepticus is characterised by changes in behaviour, memory, affect or level of consciousness. We report a case of nonconvulsive status epilepticus precipitated by carbamazepine that presented as dissociative fugue. The patient was a 49-year-old man. He first experienced a tonic-clonic seizure nine years previously and was diagnosed with grand mal epilepsy. He had been using carbamazepine 800 mg daily for the last eight years. He had not had any tonic-clonic seizures since carbamazepine was introduced but began to display behavioural disturbances periodically. He also left home many times, and remembered nothing about the period he had been away after he returned. He was hospitalised with a preliminary diagnosis of dissociative fugue. He had recurrent episodes with dissociative symptoms during his stay in the hospital. An electroencephalogram (EEG) and a 24-hour video EEG revealed nothing abnormal. An EEG recording taken during an episode indicated complex partial status epilepticus. Carbamazepine was substituted with valproate, and the patient was discharged in remission.

Nonconvulsive Status Epilepticus in a Palliative Care Unit

The search for an underlying cause of altered mental status not uncommonly becomes more challenging in the hospice and palliative care setting. Due to multiple coexisting conditions that affect mental status and shifting goals of care, discerning that single cause in this venue can become frustrating and even nonbeneficial at times. We present a case of nonconvulsive status epilepticus (NCSE), which multiple reports have shown to be a rarely contemplated cause of impaired consciousness. A concise review of NCSE follows, with emphasis on conditions that present similarly, precipitating factors, diagnostic and therapeutic considerations, and prognostic implications. Nonconvulsive status epilepticus is a reversible cause of altered consciousness, particularly when recognized promptly. In a palliative care unit, treatment should ultimately be guided by the patient's goals of care.

Ifosfamide Chemotherapy and Nonconvulsive Status Epilepticus

We present a patient with peritoneal carcinosarcoma who was treated with the alkylating agent ifosfamide and experienced a rapid decline in mental status. Electroencephalogram (EEG) displayed generalized periodic epileptiform discharges, which raised suspicion for nonconvulsive status epilepticus (NCSE). Following administration of midazolam, the patient's clinical condition and EEG improved. We review the 8 documented cases of ifosfamide-induced NCSE, and demonstrate the similarity in clinical features when compared with ifosfamide neurotoxicity that is not classified as NCSE. EEG findings suggesting an ictal pattern are subtle and heterogeneous, but they are essential for a diagnosis. Since it is unlikely that EEGs are uniformly obtained in instances of ifosfamide neurotoxicity, many cases of NCSE may go unrecognized.

A Case of Nonconvulsive Status Epilepticus with a Reversible Contralateral Cerebellar Lesion: Temporal Changes in Magnetic Resonance Imaging and Single-Photon Emission Computed Tomography Finding

A 67-year-old woman was brought to our institution because of unconsciousness. Clinical and electrophysiological findings lead us to diagnose her with nonconvulsive status epilepticus. Initial magnetic resonance imaging revealed hyperintensity in the left cerebral cortex and the right cerebellum on diffusion-weighted image and fluid-attenuated inversion recovery (FLAIR). Single-photon emission computed tomography showed increased blood flow in the left frontal cerebrum but not in the right cerebellum. The hyperintensity in the left cerebrum on the follow-up FLAIR was still present. The contralateral cerebellum remained undamaged even though the blood flow was not increased in this region because the excitotoxicity there was far lesser than that in the cerebrum.

When Physicians Disagree

Differences of opinion among attending physicians, resident trainees, and nurses are not uncommon in hospital situations. When such cases arise, ethical dilemmas must be approached with mindfulness of basic ethics principles and communication. This article presents a case of nonconvulsive status epilepticus to highlight these considerations.

Nonconvulsive Status Epilepticus in Schizophrenia: Focus on Early Detection

Back to table of contents Previous article Next article LettersFull AccessNonconvulsive Status Epilepticus in Schizophrenia: Focus on Early DetectionChih-Sung Liang, M.D., and Fei-Wen Yang, M.D.Chih-Sung LiangSearch for more papers by this author, M.D., and Fei-Wen YangSearch for more papers by this author, M.D.Published Online:1 Oct 2011https://doi.org/10.1176/jnp.23.4.jnpe26AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Nonconvulsive status epilepticus (NCSE) as a condition with a change in consciousness associated with continuous epileptiform discharges in the EEG is easily treated but often underdiagnosed.1 This is partially explained by its absence of major motor signs and protean manifestations seen in nonepileptic disorders. We present a case of NCSE and highlight early detection of this condition in patients with schizophrenia.Case ReportA 64-year-old woman with schizophrenia, which was well managed by risperidone 4 mg/day, fludiazepam 0.75 mg/day, and flunitrazepam 2 mg/day in recent years, was brought to the emergency department because of an abrupt onset of an altered level of consciousness, irritability, and psychosis. Laboratory results showed hyponatremia (115 mmol/liter) and hypokalemia (2.6 mmol/liter). Otherwise, abdominal ultrasonography, brain CT, CSF analysis, and other examinations revealed no remarkable findings. The family reported that for the past few days, there had been a marked excess of water intake. With a diagnosis of polydipsia-induced hyponatremia, she was admitted for electrolyte replacement.Upon admission, the treating physicians instantly discontinued all psychotropics. Because her condition did not improve even as her serum sodium and potassium concentrations were restored, psychiatric consultation was requested on Hospital Day 4. A diagnosis of delirium was made, and risperidone 4 mg/day was resumed. Her condition, however, gradually worsened. On Hospital Day 7, an EEG was obtained, which revealed generalized epileptiform discharges. The brain MRI showed negative findings. Consultation with a neurologist resulted in a diagnosis of NCSE; a regimen of levetiracetam 1,500 mg/day and intravenous valproic acid 1,200 mg/day was started, and risperidone was withheld. Four days after the initiation of antiepileptic agents, the patient's condition was notably improved. An EEG performed subsequently did not show any further epileptiform discharges.DiscussionThis case illustrates the complexities involved in distinguishing NCSE from other causes contributing to the development of delirium. Considering NCSE as a cause of delirium without an EEG is a great challenge because of the significant overlap in clinical features between NCSE and delirium. Misdiagnosis of NCSE could place psychiatrists at risk of iatrogenic error, because delayed treatment or exposure to antipsychotic agents that could lower seizure threshold might aggravate NCSE. Benzodiazepine (BZD) withdrawal, antipsychotic treatment, and delay in diagnosis might have worked in combination to exacerbate this patient's NCSE. Evidence demonstrates that patients with schizophrenia are more likely to experience seizures because of comorbid substance abuse, long-term exposure to psychotropic agents, and frequent episodes of head injury.2 Also, the behavioral and mental status changes of NCSE may incorrectly be ascribed to psychotic symptoms. A variety of precipitating factors have been implicated in NCSE, including polydipsia-induced hyponatremia,3 a previous history of seizures,1 infection,1 ECT,4 and BZD withdrawal,5 all of which are commonly associated with either the treatment of or are common comorbidities with schizophrenia.In conclusion, when evaluating patients with schizophrenia who have developed altered mental status and behavior, psychiatrists should pay more attention to whether an emergent EEG is needed in order to confirm or exclude the diagnosis of NCSE.Department of Psychiatry Beitou Armed Forces Hospital Taipei, Taiwan (R.O.C.)Correspondence: Fei-Wen Yang, M.D. Department of Psychiatry Beitou Armed Forces Hospital Taipei, Taiwan (R.O.C.) e-mail: [email protected]com.tw1. Meierkord H , Holtkamp M : Non-convulsive status epilepticus in adults: clinical forms and treatment. Lancet Neurol 2007; 6:329–339Crossref, Medline, Google Scholar2. Hyde TM , Weinberger DR : Seizures and schizophrenia. Schizophr Bull 1997; 23:611–622Crossref, Medline, Google Scholar3. Azuma H , Akechi T , Furukawa TA : Absence status associated with focal activity and polydipsia-induced hyponatremia. Neuropsychiatr Dis Treat 2008; 4:495–498Crossref, Medline, Google Scholar4. Povlsen UJ , Wildschiodtz G , Hogenhaven H , et al.: Nonconvulsive status epilepticus after electroconvulsive therapy. J ECT 2003; 19:164–169Crossref, Medline, Google Scholar5. Olnes MJ , Golding A , Kaplan PW : Nonconvulsive status epilepticus resulting from benzodiazepine withdrawal. Ann Intern Med 2003; 139:956–958Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByDe-novo non-convulsive status epilepticus in adult medical inpatients without known epilepsy: Analysis of mortality related factors and literature review15 October 2021 | PLOS ONE, Vol. 16, No. 10 Volume 23Issue 4 Fall 2011Pages E26-E26 Metrics PDF download History Published online 1 October 2011 Published in print 1 October 2011

Complex partial status epilepticus: an unusual presentation

Nonconvulsive status epilepticus (NCSE) is not uncommon, especially in the elderly population. It can occasionally present as confusion, personality change, coma, subtle motor activity and psychosis, thus causing diagnostic difficulties. We report an unusual case of NCSE which presented as psychosis-like episodes at regular intervals. The confirmation of diagnosis was aided by serial electroencephalography.

Cefepime neurotoxicity despite renal adjusted dosing

Neurotoxicity is a rare side-effect of cefepime. There are previous reports of cefepime neurotoxicity in patients whose dosages were not adjusted for their kidney disease. We report a toxic case of non-convulsive status epilepticus in a patient receiving renally-dosed cefepime. A 70-y-old woman was admitted with febrile neutropenia for which renally-dosed cefepime was started. On day 4 she developed altered mental status with orofacial myokymia. Blood and urine cultures were negative. Cerebrospinal fluid analysis was normal. Head computed tomography and magnetic resonance imaging showed no acute intracranial process. An electroencephalogram showed non-convulsive status epilepticus. Anticonvulsants were started, but she continued to have seizures. At this time, careful review of her medication list with temporal association of symptoms suggested cefepime as a probable cause and the drug was stopped. Within 24 h of discontinuation, her mental status began to improve and returned to baseline in 3 days. Our case illustrates that cefepime toxicity may still occur in patients who are dose-adjusted for renal insufficiency. It also underscores the importance of assessing for additional risk factors like history of stroke and seizures. Because cefepime-induced status epilepticus is completely reversible, prompt recognition and medication discontinuance can prevent further morbidity and mortality.