• Epilepsy
• Post-ictal psychosis
• Psychosis

• Humans
• Status Epilepticus/physiopathology
• Status Epilepticus/diagnosis
• Electroencephalography
• Epilepsy/physiopathology
• Epilepsy/diagnosis
• Epilepsy/complications

• Chronic alcoholism
• Focal nonconvulsive status epilepticus
• Lateralized periodic discharges
• SESA syndrome

• Humans
• Male
• Female
• Middle Aged
• Adult
• Electroencephalography
• Seizures/etiology
• Aged
• Alcoholism/complications
• Alcoholics
• Alcohol Withdrawal Seizures/complications

• Adrenocorticotropic hormone
• Clinical trial
• Infantile epileptic spasms syndrome
• Magnesium sulfate
• Real-world study

• Humans
• Magnesium Sulfate/therapeutic use
• Retrospective Studies
• Male
• Female
• Spasms, Infantile/drug therapy
• Infant
• Adrenocorticotropic Hormone/therapeutic use
• Treatment Outcome
• Drug Therapy, Combination
• Anticonvulsants/therapeutic use
• Electroencephalography
• China
• Propensity Score
• Cohort Studies

• No. 2022-1-5081 Capital's Funds for Health Improvement and Research
• No. 2016YFC1000707 National Key Research and Development Program of China

• GAERS
• absence status epilepticus
• alpha‐adrenergic receptors
• dexmedetomidine
• genetic absence epilepsy

• Animals
• Rats
• Dexmedetomidine
• Diazepam/adverse effects
• Epilepsy, Absence/drug therapy
• Epilepsy, Absence/genetics
• Ethosuximide
• Receptors, Adrenergic, alpha-2/genetics
• Receptors, Adrenergic, alpha-2/therapeutic use
• Seizures/drug therapy
• Status Epilepticus/chemically induced
• Status Epilepticus/drug therapy
• Valproic Acid

• 2022/02-20 ABAPKO
• 101078981 European Commission
• European Commission

• EEG
• Electroencephalography
• Post cardiac arrest
• Prognosis
• Review

• K23 HL157610 NHLBI NIH HHS

• EEG
• Salzburg criteria
• epilepsy
• non-convulsive status
• seizure

• Acute encephalopathy
• Convulsions with mild gastroenteritis
• Nonconvulsive status epilepticus
• Rotavirus

• Anticonvulsants/therapeutic use
• Child, Preschool
• Electroencephalography
• Female
• Gastroenteritis/virology
• Humans
• Rotavirus Infections/complications
• Status Epilepticus/diagnosis
• Status Epilepticus/virology

• Metabolic encephalopathy
• mortality
• non-convulsive status epilepticus

• Brazil
• Zika virus
• microcephalic
• neurodevelopment

• Interictal-ictal continuum
• Lateralized Periodic Discharges
• Neuroimaging correlation
• Seizures
• Status epilepticus

• Acute symptomatic seizures
• Generalized seizures
• Non-convulsive status epilepticus
• Thalamocortical network

To quantify the effect of inhaled 5% carbon-dioxide/95% oxygen on EEG recordings from patients in non-convulsive status epilepticus (NCSE).

Five children of mixed aetiology in NCSE were given high flow of inhaled carbogen (5% carbon dioxide/95% oxygen) using a face mask for maximum 120s. EEG was recorded concurrently in all patients. The effects of inhaled carbogen on patient EEG recordings were investigated using band-power, functional connectivity and graph theory measures. Carbogen effect was quantified by measuring effect size (Cohen’s d) between “before”, “during” and “after” carbogen delivery states.

Carbogen’s apparent effect on EEG band-power and network metrics across all patients for “before-during” and “before-after” inhalation comparisons was inconsistent across the five patients.

The changes in different measures suggest a potentially non-homogeneous effect of carbogen on the patients’ EEG. Different aetiology and duration of the inhalation may underlie these non-homogeneous effects. Tuning the carbogen parameters (such as ratio between CO₂ and O₂, duration of inhalation) on a personalised basis may improve seizure suppression in future.

Nonconvulsive status epilepticus (NCSE) is challenging to diagnose. This study aimed to describe and classify the clinical features and electroencephalography (EEG) findings of patients with de novo NCSE and to correlate them with clinical outcomes.

We retrospectively reviewed the medical and EEG records of patients admitted to our institution with altered mentation and EEG abnormalities from January 1, 2013 to December 31, 2018. We evaluated premorbid modified Rankin Scale (mRS) scores, underlying disorders, precipitating factors, clinical manifestations, laboratory tests, and outcomes after a 3-month follow-up. Patients who met the Salzburg Consensus Criteria for NCSE were categorized into good-outcome and poor-outcome groups. A good outcome was defined as 1) clinical and electrographic seizures ceasing after treatment, and 2) an mRS score of ≤2 or remaining unchanged during the 3-month follow-up. A poor outcome was defined as 1) death, 2) seizures continuing despite treatment, or 3) a follow-up mRS score of ≥3 in a patient with a premorbid mRS score of ≤2, or a follow-up mRS score that increased in a patient with a premorbid mRS score of ≥3.

The 48 included patients comprised 37 categorized into the good-outcome group and 11 into the poor-outcome group. The presence of acute metabolic disturbances was significantly correlated with poor outcome (p=0.036), while the other analyzed variables were not significantly correlated with outcomes.

Acute metabolic disturbances in NCSE are associated with poor outcomes. Adequate treatment of underlying reversible disorders alongside controlling seizures is critical for patients with NCSE.

• de novo
• metabolic
• modified Rankin Scale
• nonconvulsive status epilepticus

• Salzburg criteria
• critically ill patients
• impaired consciousness
• periodic discharge
• rhythmic delta activity

• Aneurysmal subarachnoid hemorrhage
• Incidence
• Nonconvulsive status epilepticus
• Outcome
• Treatment

• Acute confusional state
• Elderly
• Electroencephalography
• Non-convulsive status epilepticus

• Aged
• Confusion/diagnosis
• Confusion/epidemiology
• Consciousness
• Electroencephalography
• Female
• Humans
• Middle Aged
• Prevalence
• Status Epilepticus/diagnosis
• Status Epilepticus/epidemiology

• Elderly
• Intensive care unit
• Mortality
• Seizures

Status epilepticus is an emergent and critical condition which needs management without hesitation. Nonconvulsive status epilepticus (NCSE) tends to be less recognized, and its diagnosis is delayed in comparison with overt status epilepticus because of the absence of specific clinical signs. It is often difficult to make a diagnosis, particularly in patients with hepatic encephalopathy.

A 38-year-old man with a history of alcoholic liver cirrhosis presented with altered mental status; the initial diagnosis was hepatic encephalopathy. Although optimal treatment for hepatic encephalopathy was administered, the patient's mental status did not improve. A final diagnosis of NCSE was made by continuous electroencephalogram (EEG) monitoring. Treatment with levetiracetam and propofol pump was immediately started. The patient’s consciousness gradually improved after discontinuation of propofol therapy, and no further epileptic discharge was observed by EEG monitoring. After 1 wk, the patient returned to full consciousness, and he was able to walk in the hospital ward without assistance. He was discharged with minimal sequela of bilateral conjunctivitis.

In cases of persistent altered mental status without reasonable diagnosis, NCSE should be considered in hepatic encephalopathy patients with persistently altered levels of consciousness, and EEG monitoring is very important. We also recommend propofol as a safe and efficient therapy for NCSE in liver cirrhosis patients.

• Nonconvulsive status epilepticus
• Hepatic encephalopathy
• Electroencephalogram
• Propofol
• Multidisciplinary team
• Case report

Non‐convulsive status epilepticus (NCSE) is among the differential diagnoses of decreased consciousness, but often presents a diagnostic challenge. A 65‐year‐old woman was admitted to our emergency department with bradylalia. No abnormal finding was detected by computed tomography or magnetic resonance imaging. Subsequently, acquired arterial spin‐labeling images showed hyperperfusion in the right hemisphere.

After the examination, the patient began experiencing left hemifacial seizures, which were relieved by diazepam; however, she was still agitated. Ictal confusion due to NCSE was suspected. Electroencephalography revealed periodic, generalized epileptiform activities with brief seizures of facial muscles by intermittent photic stimulation. Another supportive case of NCSE detected by arterial spin‐labeling from a 56‐year‐old right‐handed man has also been presented.

Arterial spin‐labeling magnetic resonance perfusion imaging provides valuable information regarding cerebral perfusion status in NCSE patients in emergency/acute settings.

• delirium
• electroencephalography
• encephalopathy

• EEG monitoring
• adult
• electroencephalogram
• intensive care unit
• nonconvulsive status epilepticus

Continuous electroencephalogram (CEEG) monitoring is increasingly being used for brain monitoring in neurocritical care setting. This is because of the proven effectiveness of CEEG in diagnosing nonconvulsive status epilepticus (NCSE) as a cause of unexplained consciousness disorder. CEEG has been demonstrated to be effective in determining the response to, and outcome of, NCSE treatment.

In this review article, the authors described the indication and methods of CEEG and diagnosis based on EEG pattern. As a condition characterized by unexplained consciousness disorder, NCSE is frequently encountered in the neurocritical care setting and is only accompanied by an altered EEG change without any clinically apparent manifestation, such as convulsion. Thus, it is considered a form of status epilepticus manifesting mainly with consciousness disorder. This is a diagnostic challenge but should not be overlooked as NCSE is a curable condition. However, CEEG is required for the correct diagnosis of NCSE, which is difficult to perform in daily clinical practice. There also are several challenges regarding urgent EEG monitoring in the intensive care unit setting, including system-related problems, such as the preparation of mobile EEG devices and collodion-applied electrodes; human resource-related problems, such as staffing of EEG technicians and physicians who can respond flexibly to unscheduled needs; and EEG-specific difficulties in interpretation/diagnosis. These issues preclude the wide spread of CEEG in daily practice.

Recently, importance of CEEG was well accepted; however, no definitive diagnostic criteria exist for identifying EEG patterns suggestive of NCSE, especially the ambiguous significance of periodic discharges (PDs) further complicates the diagnosis of NCSE. Thus, analyzing the change in EEG patterns over time is important for the correct diagnosis of NCSE. Further studies are needed to collect sufficient CEEG data and assess the outcome of patients who have undergone therapeutic interventions.

• Continuous EEG
• Nonconvulsive status epilepticus (NCSE)
• Periodic discharges (PDs)

• Status epilepticus
• continuous EEG monitoring
• highly sedating medications
• nonconvulsive status epilepticus
• refractory status epilepticus
• super-refractory status epilepticus
• treatment

• Drug Resistant Epilepsy/therapy
• Humans
• Status Epilepticus/therapy

Background: Ongoing or recurrent seizure activity without prominent motor features is a common burden in neurological critical care patients and people with epilepsy during ICU stays. Continuous EEG (CEEG) is the gold standard for detecting ongoing ictal EEG patterns and monitoring functional brain activity. However CEEG review is very demanding and time consuming. The purpose of the present multirater, EEG expert reviewer study, is to test and assess the clinical feasibility of an automatic EEG pattern detection method (Neurotrend).

Methods: Four board certified EEG reviewers used Neurotrend to annotate 76 CEEG datasets à 6 h (in total 456 h of EEG) for rhythmic and periodic EEG patterns (RPP), unequivocal ictal EEG patterns and burst suppression. All reviewers had a predefined time limit of 5 min (± 2 min) per CEEG dataset and were compared to a predefined gold standard (conventional EEG review with unlimited time). Subanalysis of specific features of RPP was conducted as well. We used Gwet's AC₁ and AC₂ coefficients to calculate interrater agreement (IRA) and multirater agreement (MRA). Also, we determined individual performance measures for unequivocal ictal EEG patterns and burst suppression. Bonferroni-Holmes correction for multiple testing was applied to all statistical tests.

Results: Mean review time was 3.3 min (± 1.9 min) per CEEG dataset. We found substantial IRA for unequivocal ictal EEG patterns (0.61–0.79; mean sensitivity 86.8%; mean specificity 82.2%, p < 0.001) and burst suppression (0.68–0.71; mean sensitivity 96.7%; mean specificity 76.9% p < 0.001). Two reviewers showed substantial IRA for RPP (0.68–0.72), whereas the other two showed moderate agreement (0.45–0.54), compared to the gold standard (p < 0.001). MRA showed almost perfect agreement for burst suppression (0.86) and moderate agreement for RPP (0.54) and unequivocal ictal EEG patterns (0.57).

Conclusions: We demonstrated the clinical feasibility of an automatic critical care EEG pattern detection method on two levels: (1) reasonable high agreement compared to the gold standard, (2) reasonable short review times compared to previously reported EEG review times with conventional EEG analysis.

• continuous EEG
• intensive care unit
• neurotrend
• non-convulsive seizures
• standardized critical care EEG terminology
• status epilepticus

• Epilepsy
• In-hospital
• Nonconvulsive status epilepticus
• Out-of-hospital
• Seizure duration
• Treatment

• electroencephalography
• intubation
• mesial temporal sclerosis
• nonconvulsive status epilepticus

• Adult
• Anticonvulsants/therapeutic use
• Electroencephalography
• Humans
• Intubation, Intratracheal
• Male
• Status Epilepticus/complications
• Status Epilepticus/diagnosis
• Status Epilepticus/drug therapy
• Status Epilepticus/therapy
• Unconsciousness/etiology

• Diagnosis
• Elderly
• Electroclinical
• Etiology
• Nonconvulsive status epilepticus
• STESS

Therapeutic hypothermia (TH) has rarely been utilized as an adjunct to anticonvulsants in treating patients with refractory convulsive status epilepticus (CSE). However, determining the effectiveness of TH in CSE is difficult due to the unavoidable use of sedative drugs to manage hypothermia. Additionally, the effectiveness of TH has not been studied in patients with refractory non-convulsive status epilepticus (NCSE). Here, we report the successful use of TH without additional sedative drugs in a patient with temporal lobe epilepsy and refractory NCSE. A 46-year-old man was referred to the neurology department because of recurrent seizure attacks. Electroencephalography (EEG) after first-line status treatment showed continuous periodic discharges consistent with NCSE. He was started simultaneously on continuous EEG monitoring and TH, but was not administered any benzodiazepines to control shivering or maintain TH. During TH, EEG abnormalities gradually improved, and the patient regained consciousness in accordance with the improvement in EEG. The patient was alert and his EEG had normalized a few days after starting TH. To the best of our knowledge, this is the first report describing the successful treatment of refractory NCSE with TH. As no sedative drugs were used during the maintenance of hypothermia, NCSE control may have been achieved by TH alone.

• Electroencephalography
• Hypothermia
• Status epilepticus
• induced

• epilepsy
• non-convulsive status epilepticus

• Seizure
• convulsive status epilepticus
• intensive care
• neurocritical care
• non-convulsive status epilepticus