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Nonconvulsive status epilepticus

Nicolas Gaspard, MD, PhD
Jeffrey Jirsch, MD, MSc., FRCPC
Lawrence J Hirsch, MD
Section Editor
Timothy A Pedley, MD
Deputy Editor
April F Eichler, MD, MPH


Nonconvulsive status epilepticus (NCSE) was originally described in patients with chronic epilepsy, but it is now recognized with increased frequency in other patient populations, especially the critically ill.  

The International League Against Epilepsy (ILAE) defines status epilepticus as a condition resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms, which lead to abnormally prolonged seizures [1]. The temporal threshold that defines an abnormally prolonged seizure depends on the type of seizure. For convulsive status epilepticus, this duration is five minutes. For NCSE, defined as status epilepticus without prominent motor symptoms, the threshold is 10 minutes.

Not included in these new definitions, but still widely used by clinicians, is the situation in which brief intermittent seizure activity without convulsions occurs without full recovery of consciousness between attacks [1,2]. In patients with baseline coma or encephalopathy, NCSE typically includes patients with more than 30 total minutes of ictal electroencephalogram (EEG) activity in any given hour of recording (ie, >50 percent of the record).

The diagnosis and treatment of NCSE are not straightforward and depend on many variables, including the clinical setting and etiology, EEG findings, and the clinical status of the patient. In addition, it is not always clear to what extent the electrographic activity contributes to clinical impairment or ongoing neuronal injury.

This topic reviews nonconvulsive status epilepticus; convulsive status epilepticus is reviewed separately. (See "Convulsive status epilepticus in adults: Classification, clinical features, and diagnosis" and "Clinical features and complications of status epilepticus in children" and "Management of convulsive status epilepticus in children".)


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