Nonconvulsive Status Epilepticus (NCSE) Presenting as Acute Confusional State

Suellen Li, Andrea Loggini and John H Pula




Background: Nonconvulsive status epilepticus (NCSE) is a critical neurological condition that is commonly under-recognized due to its myriad variability of clinical presentation. High-risk groups include epileptic patients,
the elderly, and critically ill populations. Diagnosis is supported with continuous EEG monitoring. Its treatment can follow a protocol created specifically for status epilepticus, with intravenous benzodiazepines usually given as first line therapy.
Clinical Case: This case is of a 42-year-old female with distant history of unspecified epilepsy with absence spells off anti-epileptic medications for a prolonged time, brought to the emergency room after being found acutely
confused, wandering at a train station. On initial neurological evaluation, she was disoriented, but alert. Initial workup, including brain MRI with gadolinium, electrolyte, toxicity screen, and evaluation for infection was normal. EEG was initiated and immediately demonstrated generalized continuous polyspikewave discharges, compatible with non-convulsive status epilepticus. Intravenous benzodiazepines (lorazepam 2 mg) followed by a loading dose of intravenous fosphenytoin were promptly administered with complete resolution of confusion and slow return to an electrographically normal background rhythm of 9-10 Hz. She was observed for 24 hours and discharged the following day on antiepileptic medication.
Conclusions: Acute confusional state, even in absence of focal neurological findings, must raise the question of NCSE. EEG is a rapid diagnostic tool that should be performed in all suspected cases. Early diagnosis and prompt treatment prevent further clinical deterioration, refractory disease, and irreversible neurological damages. Ready access to EEG testing and interpretation is critical for the timely identification and treatment of these patients.

Published on: December 02, 2019
doi: 10.17756/jnen.2019-060
Citation: Li S, Loggini A, Pula JH. 2019. Nonconvulsive Status Epilepticus (NCSE) Presenting as Acute Confusional State. J Neurol Exp Neurosci 5(2): 100-102.