Authors :
Presenting Author: QinLan Xu, Master's degree in medicine – Department of Neurology, Peking University International Hospital, Beijing, China
Qing Xia, BS – Department of Neurology, Peking University International Hospital, Beijing, China
HongChuan Niu, MD – Department of Neurosurgery, Peking University International Hospital, Beijing, China
XianZeng Liu, MD, PhD – Department of Neurology, Peking University International Hospital, 3．Clinical Research Institute, Institute of Advanced Clinical Medicine, Peking University, Beijing, China
Rationale: Non-convulsive status epilepticus (NCSE) is defined as a paroxysmal change in behavior and/or mental processes from baseline with continuous EEG discharges but without convulsions. Rapid diagnosis is challenging due to its subtle, heterogeneous symptoms.This article summarizes NCSE electroencephalographic, clinical, epidemiological, and therapeutic aspects.
Methods:
We conducted a retrospective analysis of clinical data from patients with NCSE admitted to the Center for Neurology, Peking University International Hospital, a single tertiary academic hospital, between March 2017 and June 2024.Patients with NCSE and aged 18 years or older were reviewed. The Salzburg EEG criteria for NCSE were applied on them to identify the patients with definitive NCSE. Patients with cerebral anoxia were excluded.
Results: Thirty-four consecutive NCSE patients aged ≥18 years were reviewed after applying the Salzburg EEG criteria to confirm diagnosis, excluding those with cerebral anoxia due to poor prognosis. The median age was 67 years with balanced gender distribution (19M:15F). Pre-existing epilepsy was present in 23.5% (8/34). Etiologies were dominated by encephalitis/cerebrovascular disease (53.0%, 18/34), followed by remote head trauma/cranial surgery (14.7%, 5/34), neurodegenerative disorders (8.8%, 3/34), medication withdrawal (8.8%, 3/34), and brain tumors/post-resection (11.8%, 4/34); one case was cryptogenic. Impaired consciousness/confusion/agitation/coma occurred in 94.0% (32/34), while two patients had only subtle cognitive slowing. Focal symptoms (e.g., facial twitching, automatisms, ocular deviation) were present in 70.6% (24/34), and visual disturbances(visual hallucinations/visual field defects/and blurred vision) occurred in 17.6% (6/34). EEG showed epileptiform discharges >2.5 Hz in 41.1% (14/34); others had discharges ≤2.5 Hz plus rhythmic delta/theta >0.5 Hz. Refractoriness to first/second-line AEDs occurred in 38.2% (13/34), necessitating anesthetic agents in 26.5% (9/34) [single agent: 14.7% (5/34); combined: 8.8% (3/34)]; 14.7% (5/34) required mechanical ventilation. At 3 months, 76.5% (26/34) had favorable outcomes (mRS< 3). Unfavorable outcomes (mRS≥3, 23.5%, 8/34) stemmed from: poor baseline mRS≥3 without improvement post-seizure control (11.8%, 4/34), disability from acute stroke/encephalitis (8.8%, 3/34), and refractory NCSE with severe pneumonia causing coma/extubation failure (1 case).