Case Of Nonconvulsive Status Epilepticus Research Articles

Review of non‐convulsive status epilepticus and an illustrative case history manifesting as delirium

Non-convulsive status epilepticus can result in significant morbidity and mortality. The condition can be difficult to recognise, and can mimic delirium due to other underlying pathologies. There are several clinical subtypes, although these can be difficult to distinguish by their clinical features alone. Electroencephalogram is the key diagnostic tool to making the diagnosis, but this investigation is a limited resource in many institutions. In this review, we present a case of non-convulsive status epilepticus, manifesting as delirium, and then proceed to a literature review on this important diagnosis.

Cefepime-Induced Nonconvulsive Status Epilepticus: Case Report and Review

A case of cefepime-induced nonconvulsive status epilepticus in a 15-year-old child with end stage renal disease on hemodialysis is reported. Clinical symptoms and EEG dramatically improved 48 h after discontinuation of cefepime. Twenty-five cases of nonconvulsive status epilepticus associated with cefepime that have been reported in the literature are reviewed. The average age was 60 years [15-86], our patient is the second pediatric patient reported, and 56% of cases occurred in women. The cefepime dosage was adjusted to the renal function in 5 cases. All except 1 patient have impaired renal function (CRF: 17 cases, ARF: 7 cases). The symptoms start 1-15 days after starting cefepime, mean 6 days. The outcome was good after discontinuation of cefepime therapy and anticonvulsant treatment, but lethal outcome was also reported in 2 cases. One fatality was related to status epilepticus. The clinicians' awareness must be increased about cefepime-induced nonconvulsive status epilepticus.

Rhythmic diffuse delta frequency activity presenting as an unusual EEG correlate of nonconvulsive status epilepticus: Three case studies

We report three cases of nonconvulsive status epilepticus (NCSE) in which electroencephalograms (EEGs) were dominated by rhythmic or semirhythmic, high-voltage, diffuse, delta activity. These recordings initially contained little or no clear epileptiform activity. Two of these patients had prolonged episodes of NCSE, which were recorded with continuous long-term EEGs. These recordings revealed focal epileptiform discharges as well as persistent generalized epileptiform patterns. Rhythmic or semirhythmic, diffuse, delta activity with little or no clear epileptiform components has only rarely been reported with NCSE. Diffuse delta slowing is commonly seen in many toxic–metabolic encephalopathies, and this activity may occasionally appear rhythmic. EEG and clinical characteristics that may help distinguish these conditions are discussed.

Neuroleptic Malignant Syndrome

Neuroleptic Malignant Syndrome

IV levetiracetam in the management of non-convulsive status epilepticus

Status epilepticus (SE) is a medical emergency requiring prompt treatment to try to limit mortality and improve outcome. So far, newer antiepileptic drugs (AED) have not assumed a noticeable role in the treatment of SE. This may be in part due to the lack of IV forms for the newer AEDs. The IV form of Levetiracetam (IV-LEV) has recently become available and has a potential role in the treatment of SE. We report two cases of non-convulsive SE that responded favorably to IV-LEV. The first patient is an 83-year-old male with a history of complex partial seizure disorder who presented with impaired consciousness. The second patient is an 82-year-old male with history of old left middle cerebral artery ischemic infarction, who presented with confusion. Both patients were found to have a non-convulsive status epilepticus on electroencephalography (EEG) and treated with IV-LEV. In both cases, electrographic SE stopped with marked clinical improvement. Both patients tolerated the medication well and no significant side effects occurred. IV-LEV may have a potential role in the treatment of non-convulsive status epileptics.

Tiagabine-induced nonconvulsive status epilepticus in an adolescent without epilepsy

Tiagabine (TGB) is a γ-aminobutyric acid (GABA) reuptake inhibitor approved as adjunctive therapy for partial seizures in patients over age 12. It has been used off-label to treat depression, anxiety, bipolar disorder, neuropathic pain, headache, and spasticity. A recent epidemiologic study found that TGB adjunctive therapy does not increase the risk of status epilepticus (SE).1 However, there are now more than a dozen reports of precipitation of nonconvulsive status epilepticus (NCSE) in patients predisposed to seizures, including children,2 or in patients without epilepsy treated chronically with TGB.3 In February 2005, Cephalon, the manufacturer of TGB, issued a warning of the possibility of seizures in patients without epilepsy. We report a case of NCSE after TGB overdose in a 14-year-old girl who neither had epilepsy nor was taking the medication chronically. The present description clarifies some inaccuracies in an earlier report by others of our clinical and EEG findings in this case.4 The patient was a 14-year-old right-handed girl in good health except for mild asthma. On the day of admission, she was found at home obtunded after having ingested an estimated …

Nonconvulsive Status Epilepticus Due to Ifosfamide

To report 2 cases of nonconvulsive status epilepticus (NCSE) following infusion of ifosfamide. Two patients who received ifosfamide-containing chemotherapy developed NCSE. One woman received ifosfamide 1000 mg/m2 (1 h infusion on days 1-5); confusion, lethargy, and speech deterioration developed on day 3. The second patient developed similar symptoms on day 3 of treatment with 2500 mg/m2. Both patients responded to intravenous administration of diazepam 10 mg and were given levetiracetam as maintenance therapy. The severity and presentation of central nervous system toxicity due to ifosfamide varies greatly and involves a spectrum ranging from subclinical electroencephalogram changes to coma. NCSE, an epileptic disorder in which typical convulsive activity is absent, has previously been reported in only 4 patients receiving ifosfamide. Levetiracetam may be used for maintenance antiepileptic therapy after diazepam administration. Among the many presentations of ifosfamide neurotoxicity, clinicians should consider NCSE as a possible explanation for changes in consciousness in a patient receiving this agent. An objective causality assessment by use of the Naranjo probability scale revealed that NCSE due to ifosfamide was probable.

A case of nonconvulsive status epilepticus associated with focal cortical dysplasia

A 6-year-old girl who exhibited nonconvulsive status epilepticus (NCSE) as her main clinical seizure is reported. Her seizures involved abnormal eye movement that occurred every 1–2 months associated with a dulling of responsiveness and falling easily due to ataxic gait. During the seizure, her eyelids drooped so that the eyes appeared hooded and she seemed to be drunk. During the episode, she laughed or cried easily with no relation to her surroundings. Ictal EEG continuously showed diffuse high-voltage theta and slow waves with spikes and diffuse spike and waves, and interictal EEG showed spike and waves in the left frontal region. Brain magnetic resonance imaging revealed focal cortical dysplasia in the left frontal region. These findings suggested that the origin of NCSE is related to the frontal lobe.

Prognosis in nonconvulsive status epilepticus

ABSTRACT Determining the prognosis in nonconvulsive status epilepticus (NCSE) is complicated by several factors: under‐recognition of NCSE with its spontaneous resolution (thus decreasing the “denominator” of total cases that will have a poor outcome); incorrect diagnosis of NCSE based on misinterpretation of EEG “epileptiform” activity; mis‐classification of certain EEG patterns as NCSE ( e.g. PLEDs; triphasic waves); and grouping of different populations that have markedly different co‐morbidities (ambulatory patients with NCSE together with comatose patients with electrographic seizure activity on EEG). There are almost no prospective studies with premorbid neuropsychometric studies, and retrospective studies typically include isolated cases, or case series that include conditions in which the cause of NCSE itself causes cognitive morbidity. To summarize available data, absence status (ambulatory generalized non‐convulsive status epilepticus) would appear to carry no lasting morbidity. Complex partial status epilepticus in ambulatory patients rarely results in measurable permanent neurologic deficit, although rarely, short or longstanding deficits may clearly occur. Because intensive treatment with intravenous anticonvulsants ( e.g. benzodiazepines or phenytoin) can confer morbidity, the equation has not yet been made as to whether the morbidity of such intensive treatment for all cases of NCSE exceeds the morbidity of the disease itself. Larger, prospective studies will be needed to truly determine the prognosis in the different types of NCSE, stratified according to associated degrees of impairment (minimally impaired, moderately obtunded, comatose).

Two Cases of Nonconvulsive Status Epilepticus in Association with Tiagabine Therapy

We report two patients with intractable partial seizures who developed generalized nonconvulsive status epilepticus (NCSE) after receiving tiagabine (TGB). Neither had a history of absence seizures or generalized epileptic discharges on prior EEG monitoring. Clinicians need to be aware of a possible association between TGB and NCSE.

Nonconvulsive Status Epilepticus in the Emergency Room

The study reviewed emergent cases of nonconvulsive status epilepticus (NCSE) to evaluate causes of diagnostic and management delay and examined frequent diagnostic features suggestive of NCSE. In a retrospective study, we assessed the clinical presentation of 23 patients with one or more NCSE episodes, their medical history, EEG, and antiepileptic drug (AED) treatment. We also evaluated causes of diagnostic delay in patients referred to the emergency room (ER) in confusional states. There was considerable overlap in clinical features of patients with complex partial SE (CPSE) and generalized nonconvulsive SE (GNSE). Delays in seeking medical attention were common. Diagnosis was significantly delayed in 10 patients. Three cases illustrate the possible markedly different presentations of NCSE. NCSE often goes unrecognized or is mistaken for behavioral or psychiatric disturbance. The pleomorphic clinical presentation of NCSE indicates that EEG and a therapeutic trial of AEDs afford the best diagnostic measures in acute waxing and waning confusional states associated with agitation, bizarre behavior, staring, increased tone, mutism, or subtle myoclonus.