title: Adult nonconvulsive status epilepticus in a clinical setting: Semiology, aetiology, treatment and outcome.
abstract: OBJECTIVE
  Our objective was to study the semiology, aetiology, treatment and outcome of nonconvulsive status epilepticus (NCSE) in adults.
  
  
  METHODS
  All NCSE episodes in an unselected hospital cohort in the period 2004-2009 were identified, and the files reviewed. STESS (Status Epilepticus Severity Scale) was conducted retrospectively and correlated to outcome. Follow-up was undertaken after >2 years.
  
  
  RESULTS
  48 NCSEs in 39 patients, 22 men and 17 women, were found. Mean age was 63 years. 23/39 (59%) patients had established epilepsy. The underlying cause of NCSE was cerebrovascular disease in 17/39 (44%). 37/48 (77%) NCSEs were complex focal status epilepticus. 3/48 NCSEs (6.3%) lead to death, whereas 8.5% lead to severe sequelae. Cognitive sequelae were found after 14.9% of NCSEs. The outcome was worst in the group with no prior epilepsy (p=0.013). STESS had a negative predictive value of 96% (cut-off value of 3) for severe sequelae and death combined (p<0.002).
  
  
  CONCLUSIONS
  NCSE has a potential for severe sequelae and represents an emergency in need of intensive treatment. The major determinant of outcome is the underlying cause. The outcome was worse in patients without epilepsy than in patients with epilepsy. STESS is of value in predicting outcome. Cognitive sequelae following NCSE can occur, but need further investigation with prospective, systematic studies.
authors.affiliation: Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Section for Neurology, University of Bergen, Norway. Electronic address: kjersti.nesheim.power@helse-bergen.no.
authors.forename: Kjersti Nesheim
authors.initials: KN
authors.lastname: Power
authors.affiliation: Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Biological and Medical Psychology, University of Bergen, Norway.
authors.forename: Arne
authors.initials: A
authors.lastname: Gramstad
authors.affiliation: Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Section for Neurology, University of Bergen, Norway.
authors.forename: Nils Erik
authors.initials: NE
authors.lastname: Gilhus
authors.affiliation: Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Section for Neurology, University of Bergen, Norway.
authors.forename: Bernt A
authors.initials: BA
authors.lastname: Engelsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000627:therapeutic use; D015331:Cohort Studies; D004569:Electroencephalography; D004829:Epilepsy, Generalized / Q000150:complications / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012720:Severity of Illness Index; D013226:Status Epilepticus / Q000150:complications / Q000209:etiology* / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Aetiology; Epilepsy; Nonconvulsive status epilepticus; Outcome; Status epilepticus