Diagnosis & treatment of Non-Convulsive Status Epilepticus (NCSE) in ICU care patients

Treatment for NCSE typically involves the use of anti-seizure medications and may also include other therapies such as IV Benzodiazepines.

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By Dr Pawan Ojha

Epilepsy is a neurological condition in which abnormal brain activity causes seizures or, occasionally, loss of awareness along with strange behaviour and sensations. Convulsions is form of seizure that is characterized by rapid, visible involuntary muscle contractions that result in uncontrollable shaking and limb movement. It is a type of seizure that involves uncontrolled bursts of electrical activity in the brain.

However, not everyone who has a seizures will have convulsions. Non-Convulsive Status Epilepticus (NCSE) is a disorder that is more common in patients in the ICU and is associated with absence of any muscle contractions or convulsions with abnormal electrical activity.

NCSE causes a change in behaviour or confusion but does not involve any visible muscle contractions or convulsions. It accounts for an estimated incidence of 10-20 cases per 1,00,000 cases of Status Epilepticus.

Recently a 67-year-old woman, who presented with sudden onset of altered consciousness and limb weakness was treated by our team at the hospital. When we studied her brain MRI (Magnetic Resonance Imaging), it showed a large cerebral infarct. Although we started her treatment and admitted the patient to the ICU, the patient’s condition was deteriorating. As there was no explanation for this worsening condition, this made us evaluate further and we decided to conduct an EEG (Electroencephalography) study which showed abnormal electrical activities suggestive of a seizure phenomenon.

Post diagnosis, we initiated the treatment for NCSE with anti-seizure and IV anaesthetic medications with close monitoring in the ICU. Similarly, in the last one to two years, we observed a rise in the incidence of NCSE in our ICU. Most of these patients had associated large structural brain damage like Stroke.

Depending on the type of Non-Convulsive Status Epilepticus (NCSE), there are various causes of NCSE. Furthermore, it is crucial to understand that NCSE can affect persons of all ages, including young children and the elderly. Some common causes include chronic seizure disorders such as Epilepsy, structural damage like traumatic brain injury, Stroke, and intracranial infections.

The diagnosis of NCSE is typically made by a Neurologist or Epilepsy specialist, and involves investigations, which include an EEG. It is the most vital test to confirm the diagnosis of NCSE. It keeps track of the brain’s electrical activity and looks for unusual patterns that are indicative of seizures. ACT (Computed Tomography) or MRI scan of the brain may be performed to identify any structural abnormalities or lesions that may be associated with NCSE. After the diagnosis is certain, the patient will be kept under observation for seizure activity, and the doctor will modify the course of medication as necessary.

Treatment for NCSE typically involves the use of anti-seizure medications and may also include other therapies such as IV Benzodiazepines. The goal of the treatment is to stop the seizures and prevent a recurrence. The specific treatment plan will depend on the underlying cause of the NCSE and the patient’s individual needs.

The management of NCSE necessitates close observation, and modifications to the therapeutic strategy may be required if the seizures continue or recur. The mortality rates of NCSE range between 0-10 per cent, and factors increasing the mortality rates includes older age, prolonged seizures, and underlying medical conditions. Thus, early diagnosis and prompt treatment can improve outcomes in NCSE and reduce the morality rates.

(The author is a Director-Neurology Fortis Hiranandani Hospital, Vashi. The article is for informational purposes only. Please consult medical experts and health professionals before starting any therapy, medication and/or remedy. Views expressed are personal and do not reflect the official position or policy of the

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First published on: 01-04-2023 at 10:00 IST