Category: Critical Care
Keywords: Status epilepticus, non-convulsive, altered mental status, seizure, critical care, ICU, neurology (PubMed Search)
Non-Convulsive Status Epilepticus (NCSE) is generally under reported. An ICU study found 10% admissions for altered mental status (AMS) were eventually diagnosed as NCSE.
- Include NCSE in the AMS differential
- NCSE may occur with or without convulsive seizures
- Difficult to distinguish from a post-ictal state (14% of convulsive seizures convert to
- Reported mortality is up to 44%
Consider NCSE when:
- Seizure history / recent seizures
- Post-ictal period >1 hour
- Odd behaviors (e.g., chewing, blinking, personality change) and abnormal eye
movements (86% specific)
- AMS without structural, metabolic or traumatic etiology
- Patient intubated for status epilepticus
If you are unsure but suspicious of NCSE order a STAT EEG. Treat NCSE like a convulsive status.
Slattery, D. Seizures as a cause of altered mental status. Emerg Med Clin North Am. 2010 Aug;28(3):517-34.