title: No, some types of nonconvulsive status epilepticus cause little permanent neurologic sequelae (or: "the cure may be worse than the disease").
abstract: Nonconvulsive status epilepticus (NCSE) is characterized by a cognitive or behavioral change which lasts for at least 30 minutes, with EEG evidence of seizures. Although there is little argument that generalized nonconvulsive status epilepticus (GNSE) does not cause lasting deficits, there is still debate regarding the morbidity of complex partial status epilepticus (CPSE). Because the EEG is used for diagnosis, a strong argument can be made that NCSE is significantly under-recognized and diagnosed. Furthermore, since the documented cases of permanent neurologic sequelae are few, the potential permanent morbidity from CPSE may be significantly exaggerated. The literature indicates that comatose patients have a poor prognosis largely as a result of comorbid conditions and coma, whereas lightly obtunded or slightly confused patients with NCSE have little or no sequelae. Patients with NCSE may suffer (hypotension and respiratory suppression) from iatrogenic 'aggressive' treatment with intravenous anti-epileptic drugs (IV-AEDs), and the findings in the literature indicate that subjects treated with benzodiazepines may have a worse prognosis. The clinician must balance the potential but rare neurologic morbidity associated with NCSE against the not infrequent morbidity caused by IV-AEDs. Better stratification of the level of consciousness and comorbid conditions is needed when evaluating outcomes so as to clearly distinguish among the deficits due to: comorbid conditions; the effects of treatment and the effects of status epilepticus (SE) proper.
authors.affiliation: Johns Hopkins Bayview Medical Center, Department of Neurology, 4940 Eastern Avenue, Baltimore, MD 21224, USA.
authors.forename: P W
authors.initials: PW
authors.lastname: Kaplan
mesh_terms: D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D015415:Biomarkers; D001925:Brain Damage, Chronic / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D019090:Case Management; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology; D015897:Comorbidity; D003244:Consciousness Disorders / Q000209:etiology; D004569:Electroencephalography; D004832:Epilepsy, Absence / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D017029:Epilepsy, Complex Partial / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D007049:Iatrogenic Disease; D007275:Injections, Intravenous; D010751:Phosphopyruvate Hydratase / Q000097:blood; D011379:Prognosis; D018570:Risk Assessment; D013226:Status Epilepticus / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D015415:Biomarkers; D001569:Benzodiazepines; D010751:Phosphopyruvate Hydratase