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Non-convulsive status epilepticus (NCSE) - Coggle Diagram
Non-convulsive status epilepticus
(NCSE)
Definition
Status epilepticus
without prominent motor symptoms
Initiation of mechanisms that lead to abnormally prolonged seizures
Failure of the mechanisms responsible for seizure termination
Threshold is 10 minutes
When to suspect
No other cause to explain altered sensorium
*Hx of previous seizure
Unexplained stupor or confusion
*elderly taking neuroleptic drugs
Altered sensorium with subtle signs
Twitching
Blinking
Fluctuating mental status
Stroke clinically worse than expected
GTC with prolonged post-ictal peroid
Altered mental status with no other cause
to explain altered sensorium
Drug induced
Antipsychotics
AED
Carbamazepine
Antibiotics
Carbapenem
Cephalosporine
Benzodiazepine withdraw
Ifosfamide
Digoxin
Chloroquine
EEG diagnostic criteris
Without
known
epileptic encephalopathy
EDs ≤ 2.5 Hz or rhythmic delta/theta activity
EEG and clinical improvement after IV AED
Subtle clinical ictal phenomena
Typical spatiotemporal evolution
Incrementing onset(increase in voltage and change in frequency)
change in frequency >1 Hz or change in location
decrementing termination (voltage or frequency)
EDs >2.5 Hz
With
known
epileptic encephalopathy
Increase in prominence or frequency when compared to baseline
Improvement of clinical and EEG features with IV AEDs
Treatment
About same as generalized convulsive status epilepticus
Treat underlying cause
Symptoms
Behavioral
Catatonia
Automatisms
Cyclonic jerks
Eye
Eye twitching
Eye deviation
Psychologic
Paranoia
Hallucinations
Delusions
Psychosis
Mouth
Verbal perseveration
Aphasia
Speech arrest
Disorganized speech