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We discuss an interesting case of a 65-year-old man with multiple dissociative episodes which previously had been assessed as fugues. After evaluation in the memory clinic these episodes appeared to be generalized epileptic seizures, with an electro-encephalographic diagnosis of non-convulsive status epilepticus. Throughout this case, the different features that characterize an epileptic versus a psychiatric etiology are being discussed as well as other differential diagnostic considerations.
View Article and Find Full Text PDFNonconvulsive status epilepticus in patients under intensive care: Should we view epilepsy as a sleep disorder?
Epilepsia
January 2025
Epilepsy Unit, Gui de Chauliac Hospital, Montpellier, France.
Nonconvulsive status epilepticus (NCSE) was initially described in patients with typical and atypical absence status epilepticus (ASE) characterized by states of confusion varying in severity and in focal epilepsies with or without alteration of consciousness. Continuous EEG monitoring of critically ill patients has further refined the classification of NCSE into two main categories: with coma and without coma. Hypnotic, soporific or somniferous epileptic seizures do not exist.
View Article and Find Full Text PDFUse of benzodiazepines in patients with status epilepticus requiring second-line antiseizure medication treatment.
Epilepsy Res
January 2025
Department of Neurology, Vaasa Central Hospital, Vaasa, Finland.
Background: Status epilepticus (SE) is a life-threatening state that needs rapid and adequate treatment. Benzodiazepines (BZD) are used as a first-line treatment for SE, and if the desired effect is not achieved, second-line antiseizure medications are used.
Objective: To investigate whether the treatment with BZDs is performed adequately in patients with different subtypes of SE requiring second-line ASM treatment and, if not, to identify the factors influencing the suboptimal treatment.
Efficacy of delivery of care with Tele-continuous EEG in critically ill patients: a multicenter randomized controlled trial (Tele-cRCT study) study.
Crit Care
January 2025
Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama VI Road, Rachatevi, Bangkok, 10400, Thailand.
Background: Continuous electroencephalography (cEEG) has been recommended in critically ill patients although its efficacy for improving patients' functional status remains unclear. This study aimed to compare the efficacy of Tele-cEEG with Tele-routine EEG (Tele-rEEG), in terms of seizure detection rate, mortality and functional outcomes.
Methods: This study is a 3-year randomized, controlled, parallel, multicenter trial, conducted in eight regional hospitals across Thailand.
When patients with Creutzfeldt-Jakob disease are misdiagnosed as having nonconvulsive status epilepticus.
Epilepsia
January 2025
Epilepsy Unit, Hôpital Gui de Chauliac, Montpellier, France.
Contemporary studies report nonconvulsive status epilepticus (NCSE) in Creutzfeldt-Jakob disease (CJD), based on benzodiazepine (BZP)-responsive epileptiform discharges on the electroencephalogram (EEG), with the following false syllogism: (1) intravenous (IV) administration of BZPs usually suppress ictal activity in NCSE; (2) in CJD, periodic sharp wave complexes (PSWCs) are suppressed by IV BZPs; (3) therefore, these patients have NCSE. This is a simplistic and invalid conclusion, because authors of 20th-century science reports have clearly shown that IV BZPs, short-acting barbiturates, and drugs with no antiseizure effects, such as chloral hydrate and IV naloxone, suppress PSWCs, but patients fall asleep with no clinical improvement. In contrast, IV methylphenidate transiently improves both the EEG and clinical states.
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