Nonconvulsive Status Epilepticus

Patients who have AMS, even to the point of being comatose, may in fact be in nonconvulsive status epilepticus (NCSE). Nonconvulsive seizures occur in nonmotor areas of the brain (usually the temporal, frontal, or parietal regions), can be simple or complex (relating to whether consciousness is affected), and focal (partial) or generalized. Nonconvulsive status epilepticus is defined as continuous or intermittent seizure activity for more than 30 minutes as evidenced by impaired mental status, without motor convulsions.

Causes

It can also be caused by an several conditions, such as includes meningitis, sepsis, encephalitis, brain tumor, head trauma, extremely high fever, low glucose levels, or exposure to toxins.

Symptoms

Patients in NCSE are often unaware of their seizures and do not voice any complaint. Family members who become concerned about the patient's behavior typically bring him or her to medical attention.

Signs

• Automatisms, such as repetitive lip smacking, picking at clothes, smiling, head nodding, laughing inappropriately, and verbal perseveration are common.
• Level of consciousness often fluctuates. Patients may appear awake but withdrawn and confused. Alternatively, they may be drowsy and slow to respond or even comatose.
• NCSE may progress to convulsive seizure activity, resulting in focal signs such as clonic jerking of the eyelids or an extremity or tonic deviation of the head.

Treatment

The neuro-ICU may manages status epilepticus by:

• Stopping the seizures.
• Preventing or treating complications of prolonged seizure activity.
• Establishing a diagnosis and treating the underlying disorder.