Skip to main content
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2003 Feb;74(2):189–191. doi: 10.1136/jnnp.74.2.189

Non-convulsive status epilepticus: usefulness of clinical features in selecting patients for urgent EEG

A Husain 1, G Horn 1, M Jacobson 1
PMCID: PMC1738268  PMID: 12531946

Abstract

Background: Non-convulsive status epilepticus (NCSE) is status epilepticus without obvious tonic–clonic activity. Patients with NCSE have altered mental state. An EEG is needed to confirm the diagnosis, but obtaining an EEG on every patient with altered mental state is not practical.

Objective: To determine whether clinical features could be used to predict which patients were more likely to be in NCSE and thus in need of an urgent EEG.

Methods: Over a six month period, all patients for whom an urgent EEG was ordered to identify NCSE were enrolled. Neurology residents examined the patients and filled out a questionnaire without knowledge of the EEG results. The patients were divided into two groups, NCSE and non-NCSE, depending on the EEG result. The clinical features were compared between the two groups. The sensitivity and specificity of the features were calculated.

Results: 48 patients were enrolled, 12 in NCSE and 36 not in NCSE. Remote risk factors for seizures, severely impaired mental state, and ocular movement abnormalities were seen significantly more often in the NCSE group. The combined sensitivity of remote risk factors for seizures and ocular movement abnormalities was 100%.

Conclusions: There are certain clinical features that are more likely to be present in patients in NCSE compared with other types of encephalopathy. Either remote risk factors for seizures or ocular movement abnormalities were seen in all patients in NCSE. These features may be used to select which patients should have an urgent EEG.

Full Text

The Full Text of this article is available as a PDF (83.4 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aminoff M. J., Simon R. P. Status epilepticus. Causes, clinical features and consequences in 98 patients. Am J Med. 1980 Nov;69(5):657–666. doi: 10.1016/0002-9343(80)90415-5. [DOI] [PubMed] [Google Scholar]
  2. Ballenger C. E., 3rd, King D. W., Gallagher B. B. Partial complex status epilepticus. Neurology. 1983 Dec;33(12):1545–1552. doi: 10.1212/wnl.33.12.1545. [DOI] [PubMed] [Google Scholar]
  3. Celesia G. G. Modern concepts of status epilepticus. JAMA. 1976 Apr 12;235(15):1571–1574. [PubMed] [Google Scholar]
  4. DeLorenzo R. J., Waterhouse E. J., Towne A. R., Boggs J. G., Ko D., DeLorenzo G. A., Brown A., Garnett L. Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia. 1998 Aug;39(8):833–840. doi: 10.1111/j.1528-1157.1998.tb01177.x. [DOI] [PubMed] [Google Scholar]
  5. Drislane F. W., Blum A. S., Schomer D. L. Focal status epilepticus: clinical features and significance of different EEG patterns. Epilepsia. 1999 Sep;40(9):1254–1260. doi: 10.1111/j.1528-1157.1999.tb00855.x. [DOI] [PubMed] [Google Scholar]
  6. Drislane F. W. Presentation, evaluation, and treatment of nonconvulsive status epilepticus. Epilepsy Behav. 2000 Oct;1(5):301–314. doi: 10.1006/ebeh.2000.0100. [DOI] [PubMed] [Google Scholar]
  7. Drislane F. W., Schomer D. L. Clinical implications of generalized electrographic status epilepticus. Epilepsy Res. 1994 Oct;19(2):111–121. doi: 10.1016/0920-1211(94)90021-3. [DOI] [PubMed] [Google Scholar]
  8. Fountain N. B., Lothman E. W. Pathophysiology of status epilepticus. J Clin Neurophysiol. 1995 Jul;12(4):326–342. [PubMed] [Google Scholar]
  9. Gastaut H. Classification of status epilepticus. Adv Neurol. 1983;34:15–35. [PubMed] [Google Scholar]
  10. Guberman A., Cantu-Reyna G., Stuss D., Broughton R. Nonconvulsive generalized status epilepticus: clinical features, neuropsychological testing, and long-term follow-up. Neurology. 1986 Oct;36(10):1284–1291. doi: 10.1212/wnl.36.10.1284. [DOI] [PubMed] [Google Scholar]
  11. Hauser W. A. Status epilepticus: frequency, etiology, and neurological sequelae. Adv Neurol. 1983;34:3–14. [PubMed] [Google Scholar]
  12. Jagoda A., Riggio S. Nonconvulsive status epilepticus in adults. Am J Emerg Med. 1988 May;6(3):250–254. doi: 10.1016/0735-6757(88)90011-3. [DOI] [PubMed] [Google Scholar]
  13. Kaplan P. W. Nonconvulsive status epilepticus in the emergency room. Epilepsia. 1996 Jul;37(7):643–650. doi: 10.1111/j.1528-1157.1996.tb00628.x. [DOI] [PubMed] [Google Scholar]
  14. Kaplan P. W. Nonconvulsive status epilepticus. Semin Neurol. 1996 Mar;16(1):33–40. doi: 10.1055/s-2008-1040957. [DOI] [PubMed] [Google Scholar]
  15. Lowenstein D. H., Aminoff M. J. Clinical and EEG features of status epilepticus in comatose patients. Neurology. 1992 Jan;42(1):100–104. doi: 10.1212/wnl.42.1.100. [DOI] [PubMed] [Google Scholar]
  16. Mayeux R., Lueders H. Complex partial status epilepticus: case report and proposal for diagnostic criteria. Neurology. 1978 Sep;28(9 Pt 1):957–961. doi: 10.1212/wnl.28.9.957. [DOI] [PubMed] [Google Scholar]
  17. Meldrum B. S., Vigouroux R. A., Brierley J. B. Systemic factors and epileptic brain damage. Prolonged seizures in paralyzed, artificially ventilated baboons. Arch Neurol. 1973 Aug;29(2):82–87. doi: 10.1001/archneur.1973.00490260026003. [DOI] [PubMed] [Google Scholar]
  18. Tomson T., Lindbom U., Nilsson B. Y. Nonconvulsive status epilepticus in adults: thirty-two consecutive patients from a general hospital population. Epilepsia. 1992 Sep-Oct;33(5):829–835. doi: 10.1111/j.1528-1157.1992.tb02190.x. [DOI] [PubMed] [Google Scholar]
  19. Tomson T., Svanborg E., Wedlund J. E. Nonconvulsive status epilepticus: high incidence of complex partial status. Epilepsia. 1986 May-Jun;27(3):276–285. doi: 10.1111/j.1528-1157.1986.tb03540.x. [DOI] [PubMed] [Google Scholar]
  20. Treiman D. M., Delgado-Escueta A. V. Complex partial status epilepticus. Adv Neurol. 1983;34:69–81. [PubMed] [Google Scholar]
  21. Treiman D. M. Electroclinical features of status epilepticus. J Clin Neurophysiol. 1995 Jul;12(4):343–362. [PubMed] [Google Scholar]
  22. Treiman D. M. Generalized convulsive status epilepticus in the adult. Epilepsia. 1993;34 (Suppl 1):S2–11. doi: 10.1111/j.1528-1157.1993.tb05902.x. [DOI] [PubMed] [Google Scholar]
  23. Van Rossum J., Groeneveld-Ockhuysen A. A., Arts R. J. Psychomotor status. Arch Neurol. 1985 Oct;42(10):989–993. doi: 10.1001/archneur.1985.04060090071017. [DOI] [PubMed] [Google Scholar]
  24. Wasterlain C. G., Fujikawa D. G., Penix L., Sankar R. Pathophysiological mechanisms of brain damage from status epilepticus. Epilepsia. 1993;34 (Suppl 1):S37–S53. doi: 10.1111/j.1528-1157.1993.tb05905.x. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES