Nonconvulsive Status Epilepticus

This condition can present at any age, and it is of particular interest to note that it may do so de novo in the elderly, in some cases with no previous history of epilepsy.11 The individual presents with loss of skills, of unexplained origin. Again, this has been discussed in detail elsewhere.10,12 It is certainly a situation that requires urgent assessment and treatment. The clinical presentation of this condition is tremendously variable and, in particular, the degree of additional impairment can vary greatly from one person to another. Some are profoundly impaired during bouts of nonconvulsive status epilepticus, whereas in others the changes can be quite subtle; the individual may simply seem less capable on some occasions. Nonconvulsive status epilepticus can last for period of hours, days, or longer.

Unless the clinician thinks of the diagnosis, nonconvulsive status epilepticus may go unsuspected, undiagnosed, and untreated. In generalized nonconvulsive status epilepticus, an EEG during one of the phases of loss of ability should give an immediate diagnosis. Complex partial seizure nonconvulsive status epilepticus can be more difficult to diagnose. A detailed discussion of these conditions is beyond the remit of this chapter. However, it is worth noting that if nonconvulsive status epi-lepticus does not resolve rapidly it may be worth treating it with intravenous ben-zodiazepines, such as diazemuls. If the attacks are recurrent, then altering the regular antiepileptic medication can be beneficial. Drugs such as sodium valproate and/or lamotrigine are often highly effective.

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