Status epilepticus: may be non-convulsive

Clinical bottom line (level 4)

  1. A fifth of patients with status epilepticus may not be convulsing
Dunne et al: Quarterly Journal Of Medicine 1987; 62 (238): 117-126
Expires September 2003

The study

Setting: General hospital, Australia

113 patients (aged 14-81, mean 48, ?% male) Status epilepticus

Non-independent unblinded reference standard, applied in ?all patients from a consecutive appropriate spectrum.
  • status epilepticus defined as frequent or prolonged seizures lasting >30 minutes
  • non-convulsive seizure is confirmed by clouding of consciousness and EEG indicating ictal activity

The evidence

pre-test probability of non-convulsive status epilepticus: 19.5%, (95% CI: 12.2% to 26.8%)

differential diagnosis number of patients prevalence
(95% CI)
Recent infection 3 13.6%
(2.9% to 34.9%)
Poor drug compliance or inadequate plasma anticonvulsant levels 3 13.6%
(2.9% to 34.9%)
Change of therapy 3 13.6%
(2.9% to 34.9%)
Recent surgery 2 9.10%
(1.1% to 29.2%)
Alcohol 1 4.5%
(0.1% to 22.8%)
Sleep deprivation 1 4.5%
(0.1% to 22.8%)

  • Number of patients is too small for aetiology purposes.
  • Patients responded to diazepam

Comments

  1. Important to realise that patients with clouded consciousness may be in non-convulsive status epilepticus.
  2. No information on how long doctors took to diagnose non-convulsive status, and any sequelae

Citation

  1. Dunne JW, Summers QA, Stewart-Wynne EG: Non-convulsive status epilepticus: a prospective study in an adult general hospital. Quarterly Journal Of Medicine 1987; 62 (238): 117-126
Contributor: Chris Ball and Musab Hayatli, October 2000
Reviewer: Michael Nielsen

Clinical Question.
Patient suspected status epilepticus, non-convulsive
Intervention or Exposure prevalence
Outcome confirmed status epilepticus