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non-convulsive status epilepticus

Prolonged generalized partial seizures or absence seizures. Etiology: - may complicate postictal state of convulsive status epilepticus Epidemiology: 1) 52% with acute medical illness involving CNS - 13% with history of epilepsy 2) 31% with previous history of epilepsy, but no acute illness 3) 17% with no acute illness & no history of epilepsy 4) frequently unrecognized [3] Clinical manifestations: 1) no frank convulsive movements 2) mental status changes variable a) cognitive impairment b) behavioral changes - repeated episodes of staring - lip smacking c) obtundation, nonresponsiveness to coma (33%) d) post-ichtal lethargy e) intermittent periods of baseline mental status 3) may present as persistent altered mental status after treatment of convulsive status epilepticus [4] - waxing & waning - focal neurologic deficits (aphasia, dysarthria ...) 4) suspect in critically ill patient with altered mental status without clear cause [4] Special laboratory: - EEG monitoring [4] - continuous seizure activity on EEG - 24 hour monitor, 48 hours if comatose [4] Diagnosis: - video EEG monitoring - paradoxical improvement in mental status with low-dose benzodiazepine [4] Management: 1) correct hypoglycemia - 50 mL of 50% dextrose with 100 mg of thiamine IV 2) not acutely life-threatening 3) does not require immediate or aggressive management 4) bolus administration of patient's maintenance therapy if subtherapeutic [4] 5) prognosis a) overall mortality 18% b) comorbidity increases mortality

General

status epilepticus

References

  1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 541
  2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 645-46
  3. Journal Watch 23(23):186, 2003 Shneker BF & Fountain NB, Assessment of acute morbidity and mortality in nonconvulsive status epilepticus. Neurology 61:1066, 2003 PMID: 14581666 Kaplan PW, Neurology 61:1035, 2003
  4. Medical Knowledge Self Assessment Program (MKSAP) 14, 16, 17, 18, 19. American College of Physicians, Philadelphia 2006, 2012, 2015, 2018, 2021
  5. NEJM Knowledge+ Psychiatry