Diagnosis and treatment of nonconvulsive status epilepticus in children / 中华实用儿科临床杂志

The Neurocritical Care Society′s Guidelines for the Evaluation and Management of Status Epilepti-cus defines status epilepticus as the epilepsy lasts for 5 minutes or longer,with continuous clinical and/or electrographic seizure activity or recurrent seizure activity without recovery (returning to baseline) between seizures.Nonconvulsive status epilepticus (NCSE) can be classified into with or without coma/stupor types.The diagnosis of NCSE needs continuous video electroencephalogram monitoring and the indications include:(1) altered mental status appear after seizures,acute brain injury or other unknown causes;(2)efficacy evaluation of seizure therapy is performed to confirm whether nonconvulsive seizures or NCSE is controlled monitoring for 24 to 48 hours;(3)identification of cerebral ischemia.Modified Salzburg consensus criteria for NCSE suggests that the diagnosis of NCSE needs the combination of clinical features and electroencephalograms.Suspected clinical features and signs of NCSE should last at least 10 minutes,and altered EEG of suspected NCSE should last at least 10 seconds.Benzodiazepines is the first choice of treatment in NCSE and antiepileptic drugs are selected if necessary.If the NCSE lasts longer than 60 minutes,anesthetics or other therapies may be administered.

Clinical features and electroencephalogram findings of nonconvulsive status epilepticus in children / 中华实用儿科临床杂志

Nonconvulsive status epilepticus (NCSE)is a peculiar kind of status epilepticus,which is not un-common in children,but it always be misdiagnosed due to its unnoticeable clinical signs.So far,there is no international unifying diagnose standard of NCSE.Therefore,electroencephalography(EEG)monitoring is recommended.Now,the progress in this field of clinical manifestation and EEG features of NCSE was reviewed.

Ceftazidime-Induced Nonconvulsive Status Epilepticus

Ceftazidime is a widely used third-generation cephalosporin. We report a case of ceftazidime-induced nonconvulsive status epilepticus in a patient with renal failure. A 56-year-old man experienced the gradual development of altered mentation after a diabetic foot ulcer was treated with ceftazidime. Rhythmic sharply contoured triphasic waves were evident in all electroencephalography leads. The clinical and electrographical seizures ceased after introducing antiepileptic drugs and discontinuing ceftazidime. This case demonstrates that altered mentality and nonconvulsive status epilepticus can be caused by ceftazidime in patients with renal dysfunction.

Ceftazidime-Induced Nonconvulsive Status Epilepticus

Ceftazidime is a widely used third-generation cephalosporin. We report a case of ceftazidime-induced nonconvulsive status epilepticus in a patient with renal failure. A 56-year-old man experienced the gradual development of altered mentation after a diabetic foot ulcer was treated with ceftazidime. Rhythmic sharply contoured triphasic waves were evident in all electroencephalography leads. The clinical and electrographical seizures ceased after introducing antiepileptic drugs and discontinuing ceftazidime. This case demonstrates that altered mentality and nonconvulsive status epilepticus can be caused by ceftazidime in patients with renal dysfunction.

A Comatose Patient with Continuous Generalized 3 Hz Spike-and-Wave Discharges after Cardiac Arrest

The electroencephalogram exhibits continuous epileptiform discharges in many advanced coma stages, described as comatose nonconvulsive status epilepticus (NCSE). Comatose NCSE might represent an irreversible brain damage, but its causal role remains unclear. We experienced a comatose patient with continuous generalized 3 Hz spike-and-wave discharges after cerebral anoxia, which is a quiet similar electroencephalographic pattern of typical absence status epilepticus. This case indicates that NCSE in comatose patients may be overdiagnosed if the diagnosis is based on electroencephalographic alterations alone.

A Comatose Patient with Continuous Generalized 3 Hz Spike-and-Wave Discharges after Cardiac Arrest

The electroencephalogram exhibits continuous epileptiform discharges in many advanced coma stages, described as comatose nonconvulsive status epilepticus (NCSE). Comatose NCSE might represent an irreversible brain damage, but its causal role remains unclear. We experienced a comatose patient with continuous generalized 3 Hz spike-and-wave discharges after cerebral anoxia, which is a quiet similar electroencephalographic pattern of typical absence status epilepticus. This case indicates that NCSE in comatose patients may be overdiagnosed if the diagnosis is based on electroencephalographic alterations alone.

Nonconvulsive Status Epilepticus Associated with Hashimoto's Encephalopathy / 대한임상신경생리학회지

Nonconvulsive status epilepticus usually presents with altered mentation without distinct manifestations of seizures. It may be related with various medical disorders. Hashimoto's encephalopathy is characterized by various neurological manifestations accompanied by high titers of anti-thyroid antibodies. Here, we report a patient with nonconvulsive status epilepticus caused by Hashimoto's encephalopathy who showed a dramatic response to steroids.

Video-electroencephalogram monitoring in children with nonconvulsive status epilepticus / 中华实用儿科临床杂志

Objective To explore the clinical features and video-electroencephalogram (VEEG) monitoring of nonconvulsive status epilepticus (NCSE) in children.Methods 1.Object of study:Seventeen patients of NCSE diagnosed with Kaplan's criteria were analyzed in Children's Hospital of Fudan University between Oct.2009 and Sep.2012.2.Data analysis:Data on demographics,etiology,clinical manifestation and response to clonazepam therapy were analyzed.3.Therapies:Clonazepam 0.05 mg/kg was intravenously injected twice a day.Treatment of poor efficacy patients was combined with other antiepileptic drugs.4.Therapeutic effect:Clinical assessment of cognitive improvement and VEEG monitoring of background activity or paroxysmal abnormalities were analyzed.Results Nine male and 8 female of 17 patients with NCSE were involved,from 11 months to ll.4-year old.The clinical attacks lasted ranging variously time from 4 hours to 3 months.Each patient had a prolonged change of consciousness,accompanied by psychological or behavioral changes.Definite medical causes were identified in 65％ (11/17 cases) of the patients.Secondary epilepsy was the dominating cause.The characteristics of ictal VEEG in NCSE generally included slow activity and focal or generalized δ or θ activity.After clonazepam treatment,the conditions of 13 patients were under complete control,in which 4 had improvement.Six cases of unknown cause were fully controlled within 72 hours after intravenous injection of clonazepam.The prognosis of CNS infection sequelae patients,metabolism disorders and brain structural damage was poor.Conclusions NCSE may present with confusion,behavioral disturbances and psychiatric conditions.The diagnosis can be made by the ictal and interictal VEEG monitoring.It is necessary to make the diagnosis and control the seizures as quickly as possible.Clonazepam is useful in NCSE.

Refractory nonconvulsive status epilepticus in coma: analysis of the evolution of ictal patterns / Estado de mal epiléptico não convulsivo refratário no coma: análise da evolução dos padrões ictais

OBJECTIVE: Nonconvulsive status epilepticus (NCSE) is currently considered as one of the most frequent types of status epilepticus (SE). The objective of the present study was to identify the natural history of the electrographical evolution of refractory NCSE and to establish the relationship between ictal patterns and prognosis. METHODS: We analyzed, retrospectively, 14 patients with loss of consciousness and NCSE. The ictal patterns were classified as discrete seizures (DS), merging seizures (MS), continuous ictal discharges (CID), continuous ictal discharges with flat periods (CID-F), and periodic lateralized epileptiform discharges (PLEDs). RESULTS: The ictal patterns were DS (n=7; 50.0%), PLEDs (n=3; 1.4%), CID (n=2; 14.3%), MS (n=1; 7.1%), and CID-F (n=1; 7.1%). CONCLUSIONS: NCSE electrographic findings are heterogeneous and do not follow a stereotyped sequence. PLEDs were related to a higher probability of neurological morbidity and mortality.

OBJETIVO: Estado de mal epiléptico não convulsivo (EMENC) é atualmente considerado uma das formas mais frequentes de estado de mal epiléptico. O objetivo deste estudo foi identificar a história natural da evolução eletrográfica do EMENC refratário, bem como estabelecer relações entre padrões ictais e o prognóstico. MÉTODOS: Foram analizados, retrospectivamente, 14 pacientes com comprometimento da consciência e EMENC. Os padrões ictais foram classificados em crises isoladas (CI), crises subintrantes (CS), descarga ictal contínua (DIC), descarga ictal contínua com períodos de atenuação (DIC-A) e descargas epileptiformes periódicas lateralizadas (PLEDs). RESULTADOS: Os padrões ictais observados foram CI (n=7; 50,0%), PLEDs (n=3; 1,4%), DIC (n=2; 14,3%), CS (n=1; 7,1%) e DIC-A (n=1; 7,1%). CONCLUSÕES: Achados eletrográficos no EMENC refratário são heterogêneos e não obedecem a uma sequência estereotipada. As PLEDs estão associadas à maior probabilidade de morbidade e mortalidade neurológica.

Nonconvulsive Status Epilepticus Caused by Cephalosporins in Patients with Renal Failure

PURPOSE: To describe the clinical features of nonconvulsive status epilepticus (NCSE) associated with cephalosporins in patients with renal failure and to emphasize the importance of EEG in diagnosing NCSE in patients with altered consciousness.METHODS: We described the detailed clinical characteristics of 8 patients with renal failure who underwent cephalosporin-induced NCSE.RESULTS: Six of the patients showed unresponsiveness with preserved alertness and two patients presented confusion and irritability. 6 patients presented altered consciousness with intermittent jerky movements of face or arms. Altered consciousness developed 6+/-5 days (mean+/-SD) after starting the above antibiotics. The EEG showed continuous generalized high voltage 1.0 to 2.5 Hz sharp waves or sharp and wave complexes. All patients improved 3+/-1 days after withdrawing the offending antibiotics without administration of antiepileptic drugs.CONCLUSIONS: Cephalosporin-induced NCSE should be differentiated from metabolic encephalopathy in patients with renal failure, which is clinically difficult. Early detection with EEG and withdrawal of the offending antibiotics can result in full recovery.

Nonconvulsive Status Epilepticus as the First Manifestation of Hashimoto's Encephalopathy

Hashimoto's encephalopathy (HE) is an uncommon syndrome accompanied by Hashimoto's thyroiditis. It is an immune-mediated disorder characterized by subacute onset of confusion, altered consciousness, seizures and myoclonus. However, the diagnosis is often difficult because clinical manifestations are heterogeneous and nonspecific. Several reports of Hashimoto's encephalopathy presenting with focal or generalized seizures are described, but only few have focused on status epilepticus as the first clinical manifestation. We report a 60-year-old female patient who developed decreased consciousness with nonconvulsive status epilepticus due to Hashimoto's encephalopathy and was successfully treated with high doses of intravenous steroid.

Nonconvulsive Status Epilepticus Caused by Cephalosporins in Patients with Renal Failure / 대한간질학회지

PURPOSE: To describe the clinical features of nonconvulsive status epilepticus (NCSE) associated with cephalosporins in patients with renal failure and to emphasize the importance of EEG in diagnosing NCSE in patients with altered consciousness. METHODS: We described the detailed clinical characteristics of 8 patients with renal failure who underwent cephalosporin-induced NCSE. RESULTS: Six of the patients showed unresponsiveness with preserved alertness and two patients presented confusion and irritability. 6 patients presented altered consciousness with intermittent jerky movements of face or arms. Altered consciousness developed 6+/-5 days (mean+/-SD) after starting the above antibiotics. The EEG showed continuous generalized high voltage 1.0 to 2.5 Hz sharp waves or sharp and wave complexes. All patients improved 3+/-1 days after withdrawing the offending antibiotics without administration of antiepileptic drugs. CONCLUSIONS: Cephalosporin-induced NCSE should be differentiated from metabolic encephalopathy in patients with renal failure, which is clinically difficult. Early detection with EEG and withdrawal of the offending antibiotics can result in full recovery.

Nonconvulsive Status Epilepticus as the First Manifestation of Hashimoto's Encephalopathy / 대한간질학회지

Hashimoto's encephalopathy (HE) is an uncommon syndrome accompanied by Hashimoto's thyroiditis. It is an immune-mediated disorder characterized by subacute onset of confusion, altered consciousness, seizures and myoclonus. However, the diagnosis is often difficult because clinical manifestations are heterogeneous and nonspecific. Several reports of Hashimoto's encephalopathy presenting with focal or generalized seizures are described, but only few have focused on status epilepticus as the first clinical manifestation. We report a 60-year-old female patient who developed decreased consciousness with nonconvulsive status epilepticus due to Hashimoto's encephalopathy and was successfully treated with high doses of intravenous steroid.

Cefepime-Induced Nonconvulsive Status Epileticus Presenting as Coma in a Patient with ESRD on Hemodialysis / 대한신장학회지

Cefepime-induced nonconvulsive status epilepticus (NCSE) in end-stage renal disease (ESRD) patients receiving hemodialysis has only rarely been reported. Here we report a case of cefepime-induced NCSE presenting as coma in a patient with ESRD on hemodialysis. A 73-year-old man, who had been receiving maintenance hemodialysis, developed aphasia and coma during cefepime therapy for epidural abscess. Emergent eletroencephalography (EEG) revealed evidence of NCSE. The abnormal EEG findings were resolved and comatose mentality was completely recovered after cessation of cefepime and administration of anticonvulsive drugs. Cefepime-induced NCSE should be considered if neurological symptoms including comatose mentality develops during cefepime therapy in a patient with renal failure.

Estado de mal epiléptico / Status epilepticus

INTRODUÇÃO: O estado de mal epiléptico (EME) é subdiagnosticado, especialmente as formas clínicas com sinais motores sutis ou apenas com alteração da consciência. É uma emergência neurológica que necessita diagnóstico imediato e a tratamento agressivo e para prevenir lesão neuronal. OBJETIVOS: Revisar, discutir e propor protocolo para o tratamento desta condição. METODOLOGIA: A literatura foi selecionada a partir de pesquisa nas bases de dados MEDLINE e PUBMED. RESULTADOS: Propomos um protocolo utilizando diazepam, fenitoína, fenobarbital, midazolam, thiopental e pentobarbital ainda nos casos refratários topiramato ou levetiracetam. CONCLUSÕES: Um protocolo estruturado para a investigação da etiologia e tratamento do EME é necessário e possibilita melhores chances de evolução dos casos.

INTRODUCTION: Status epilepticus (SE) is an under recognized medical emergency, especially subtle SE or clinical presentation mostly with conscience disturbance (nonconvulsive SE). It is a medical emergency that requires immediate and aggressive diagnoses and treatment. OBJECTIVES: Review, discuss and a protocol suggestion for treatment. METHODOLOGY: Literature publication was selected from MEDLINE and PUBMED. RESULTS: A protocol with diazepam, phenytoin, phenobarbital, midazolam, thiopental and pentobarbital, including topiramate and levetiracetam for refractory cases was proposed. CONCLUSIONS: A standardized protocol for SE work-up and treatment is useful and probably improves outcome.

Isoflurane Anesthesia Therapy for Nonconvulsive Status Epilepticus Continuing after the Control of Convulsive Status Epilepticus: A case report / 대한마취과학회지

Nonconvulsive status epilepticus (NCSE) is defined as continuous or nearly continous electrographic seizure activity lasting at least 30 minutes without clinical signs of convulsive activity. The presence of NCSE after the control of clinical status epilepticus (SE) is a significant prognostic indicator of outcome for SE. We report a case of a 25 year-old male patient that had viral encephalitis and showed electrographic seizure on electroencephalography (EEG) that persisted after the control of convulsive status epilepticus. The patient was treated with isoflurane under general anesthesia for 5 days after the standard antiepileptic drugs failed. We discontinued the use of isoflurane after NCSE reached optimal burst suppression, as seen on EEG, and it was controlled well with antiepileptic drugs.

Probable Nonconvulsive Status Epilepticus after Drainage of a Chronic Subdural Hematoma in a Patient with Moyamoya Disease

A 52-year-old woman with hypertension and moyamoya disease presented with chronic subdural hematoma (CSDH). The presumed cause of bleeding was ascribed to administrated antiplatelet agents. She responded slowy and clumsily to verbal commands and had right arm weakness. After surgery, her clinical condition improved. But two days after surgery, her symptoms became aggravated and a convulsive seizure was noted within 24 hours. Brain magnetic resonance imaging showed no organic lesion except a small amount of residual CSDH. In addition, there was no laboratory evidence of metabolic brain disease. Moreover, after the administration of an antiepileptic drug (phenytoin), her manifestations disappeared. Therefore, the authors presume that her symptoms were resulted from nonconvulsive status epilepticus (NCSE), despite a lack of ictal period electroencephalographic findings. The authors were unable to find a single case report on postoperative NCSE in Korea. Therefore, the authors report this case of nonconvulsive status epilepticus after drainage of a CSDH in a patient with moyamoya disease.

18F-FDG PET and 99mTc-ECD SPECT between Ictal and Interictal Phase in a Patient with Status Epilepticus Arising from the Occipital Lobe

A 35-year-old woman suffered from elementary visual symptom that was confirmed as nonconvulsive simple partial status epilepticus arising from the right occipital lobe. 99mTc-ECD SPECT and 18F-FDG PET were done during the ictal and interictal phase, respectively, which were documented by EEG. Subtraction images of SPECT and PET were overlayed on the MRI by SISCOM to compare the area of metabolic change with that of perfusion change. There was no definite mismatch between the hypermetabolic area and the hyperperfusion area during nonconvulsive status epilepticus.

Generalized Nonconvulsive Status Epilepticus in Two Patients with End-Stage Renal Disease

We report two patients of generalized nonconvulsive status epilepticus (GNSE) accompanied by end-stage renal disease. Both patients were presented with impaired responsiveness and behavioral abnormalities. Continuous generalized epileptiform discharges were noted on EEG. GNSEs of our patients were responsive to benzodiazepines clinically and electroencephalographically. And they were controlled by short-term antiepileptic treatment and improvement of uremic condition. (J Korean Neurol Assoc 19(5):533~536, 2001)

Nonconvulsive Status Epilepticus of Frontal Origin: 2 Cases

Nonconvulsive status epilepticus (NCSE) of frontal origin is rare. The symptoms are unusual and different from that of temporal origin which makes it difficult to be diagnosed. We report two cases with NCSE of frontal origin. The first case was a 17-year-old girl who presented indifference and reduced word fluency, responsiveness, and facial expres-sion daylong with intermittent unresponsiveness and slight rightward eye and head deviations. Confusion was not noted. Electroencephalogram (EEG) showed the recurrent 2 Hz spike-wave ictal discharges on the left frontal area, sometimes spreading to the opposite side. The second case was a 57-year-old woman who had a medically intractable epilepsy. During long-term Video/EEG monitoring, the continuous 2 Hz spike-and-wave complexes were noted on the right hemisphere and the left frontal area. At that time, neurological examination including cognitive functions was normal except for a mild jaw tremor. No confusion was noted. However, she looked depressed, inactive, and affectively indifferent. Intravenous lorazepam injection abolished status EEG activities as well as clinical symptoms. Ictal single photon emission computed tomography (SPECT) showed an increased perfusion in the right frontal lobe. Cortical dysplasia was pathologically diagnosed after a right frontal lobectomy.