Non-convulsive status

Question 1

What is the definiton of non-convulsive status epilepticus?

Answer 1

a change in behaviour from baseline, accompanied by continuous epileptiform discharges in the EEG

Question 2

How is non-convulsive status epilepticus generally classified?

Answer 2

generalised or focal

Question 3

What are 3 groups into which generalised NCSE can be classed?

Answer 3

1. Absence
2. De novo late-onset absence
3. Atypical absence

Question 4

What is absence status characterised by?

Answer 4

confusion or decreased responsiveness, with infrequent blinking, lasting hours to days, with an EEG showing generalised spike and slow-wave discharges

Question 5

What does EEG show in absence status?

Answer 5

generalised spike and slow-wave discharges

Question 6

What are the 2 groups into which focal NCSE can be classed?

Answer 6

simple (aware) and complex (impaired awareness)

Question 7

What does focal impaired awareness status involve?

Answer 7

• repetitive or prolonged focal impaired awareness seizures, producing confusion or a labile level of consciousness
• other confused or comatose patients with rhythmic, rapid epileptiform discharges on the EEG may have so-called ‘electrographic’ status epilepticus and can be regarded within the same diagnostic category

Question 8

How is NCSE distinguished from encephalopathies on EEG?

Answer 8

NCSE indicated by incremental evolution fo regional or generalised rhythmic discharges, and decremental features with flat periods associated with clinical seizure activity

Question 9

Why should a diagnosis of NCSE not be based on EEG changes alone?

Answer 9

comatose patients can have periodic and rhythmic EEG changes that are not usually pathognomonic

Question 10

What are 4 diagnostic features of NCSE?

Answer 10

1. Abnormal mental status examination
2. Decreased responsiveness
3. Supportive EEG
4. Good response to antiepilpetic treatment

Question 11

Does a poor response of suspected NCSE to AEDs rule out the diagnosis?

Answer 11

no

Question 12

Is NCSE associated with extensive morbidity and why/why not?

Answer 12

no, it is the underlying disease which is

Question 13

When can NCSE cases predispose to more permanent damage in the long term?

Answer 13

1. prolonged NCSE
2. those with focal lesions
3. systemic illness
4. very fast epileptiform discharges

Question 14

What are 3 possible adverse outcomes of NCSE meaning it should be treated expeditiously?

Answer 14

1. prolonged memory dysfunction
2. can be fatal
3. can lead to severe sequelae