Nonconvulsive status epilepticus in the emergency room.
OBJECTIVE
The study reviewed emergent cases of nonconvulsive status epilepticus (NCSE) to evaluate causes of diagnostic and management delay and examined frequent diagnostic features suggestive of NCSE.


METHODS
In a retrospective study, we assessed the clinical presentation of 23 patients with one or more NCSE episodes, their medical history, EEG, and antiepileptic drug (AED) treatment. We also evaluated causes of diagnostic delay in patients referred to the emergency room (ER) in confusional states.


RESULTS
There was considerable overlap in clinical features of patients with complex partial SE (CPSE) and generalized nonconvulsive SE (GNSE). Delays in seeking medical attention were common. Diagnosis was significantly delayed in 10 patients. Three cases illustrate the possible markedly different presentations of NCSE.


CONCLUSIONS
NCSE often goes unrecognized or is mistaken for behavioral or psychiatric disturbance. The pleomorphic clinical presentation of NCSE indicates that EEG and a therapeutic trial of AEDs afford the best diagnostic measures in acute waxing and waning confusional states associated with agitation, bizarre behavior, staring, increased tone, mutism, or subtle myoclonus.
Kaplan
P W
PW
Johns Hopkins Bayview Medical Center, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D003221:Confusion / Q000175:diagnosis; D003937:Diagnosis, Differential; D003975:Diazepam / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004569:Electroencephalography; D004636:Emergency Service, Hospital; D017029:Epilepsy, Complex Partial / Q000175:diagnosis / Q000523:psychology; D004829:Epilepsy, Generalized / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006801:Humans; D008140:Lorazepam / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009155:Mutism / Q000175:diagnosis; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D016896:Treatment Outcome
D000927:Anticonvulsants; D008140:Lorazepam; D003975:Diazepam