SEMIOLOGY, EEG AND ETIOLOGY OF NON-CONVULSIVE STATUS EPILEPTICUS
Abstract number :
2.004
Submission category :
Year :
2003
Submission ID :
3801
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Berend Feddersen, Stefan Arnold, Soheyl Noachtar Neurology, Klinikum Grosshadern, University of Munich, Munich, Germany
It has been stated that every seizure type may occur as status epilepticus. This study aimed to evaluate the semiology, etiology and course of non-convulsive status epilepticus.
We prospectively evaluated all patients with status epilepticus admitted to our hospital from 1.11.2000 to 1.4. 2003 and included 48 patients with 52 non-convulsive status epilepticus in this study.
Twentyeight of the 48 patients (58%) had a history of epilepsy. Ictal EEG showed regional EEG status patterns in 46 patients and generalized EEG status patterns in 2 patients. Status semiology was characterized equally by automatisms (automotor status) (n=16, 30%), and unresponsiveness in the absence of motor symptoms (absence) (n=16, 30%). Confusional states were present in 15% (n=8) and aphasic status in 8% (n=4). Automotor status was most commonly associated with unilateral temporal (n=8, 50%) or frontal (n=2, 13%) EEG status patterns. Infarctions were the most common etiology of automotor status (n=6, 38%). The status EEG of clinical absence status was more variable showing regional non-lateralized (n=4), unilateral frontal (n=3), unilateral central (n=2), unilateral temporal (n=1), unilateral occipital (n=1), lateralized right hemisphere (n=3), and generalized (n=1) EEG status patterns. Absence status was secondary to intracerebral bleeding in 25% (n=4), to withdrawal of antiepileptic drugs in 20% (n=3), to infection in 20% (n=3) and to hypoxia in 13% (n=2) of the patients. The confuisonal states were associated with lateralized (left n=3, right, n=1), unifrontal (n=2), and unilateral parieto-occipital (n=2) EEG status patterns. Most common causes were infarctions (n=3) and infections (n=2). Only automotor status evolved into generalized tonic-clonic status (n=4).
The EEG status patterns of clinical absence status in our series are mainly regional and more variable than the status EEG of automotor status, which is commonly unilateral temporal or frontal. Non-convulsive status may present as pure confusion, a status semiology, which is not established as a isolated seizure type. Automotor status tends to evolve into generalized tonic clonic status epilepticus, thus requiring more aggressive treatment to avoid poor outcome.