Best Case Ever 22: Nonconvulsive Status Epilepticus (NCSE)

In the first of our series on Best Case Ever of  ‘Carr’s Cases’ we have, the legend himself, Dr. David Carr telling us about his case of a patient with nonconvulsive status epilepticus (NCSE).  This series will run on the theme of interesting diagnoses that we don’t think of too often, but that are not as rare as we might think and can make a significant difference to your patient’s outcome if you pick up on them early – and maybe even make you look as smart as David! Dr. Carr will be highlighted in our upcoming episode on Whistler’s Update in EM Conference highlights 2014 when he will be speaking about his approach to the shocky patient as well as the controversial management of submassive pulmonary embolism.  He will be featured along with Dr. Lisa Thurgur speaking about lipid emulsion therapy and other toxicologic goodies and Joel Yaphe will give us his take on the best of the EM literature from 2013 including the TTM trial, tranexamic acid for epistaxis, return to sport after concussion guidelines and more.

Published by Anton Helman, May 2014

Pearls on Nonconvulsive Status Epilepticus

  1. Think about nonconvulsive status epilepticus in patients who have had seizures with prolonged post ictal phases or no cause found for their decreased level of awareness
  2. For patients whom you have ruled out all the usual causes of decreased level of awareness, try administering a dose of midazolam – if the patient’s level of awareness improves, the diagnosis is likely nonconvulsive status epilepticus
  3. Most patients with nonconvulsive status epilepticus will have very subtle abnormal eye (eg: blinking), face (eg: grimacing) or limb motor activity – take your time to look for these movements in your patients who are found down

For a great review of nonconvulsive status epilepticus go to the Life in the Fast Lane blog.

For more on the ‘found down’ patient and nonconvulsive status epilepticus with Dr. Carr and Dr. Brian Steinhart listen to Episode 13

 

Dr. Helman and Dr. Carr have no conflicts of interest to declare.

 

Key Reference

Meierkord, H. and Holtkamp, M. (2007) Non-convulsive status epilepticus in adults: clinical forms and treatment. Lancet Neurol 6: 329–339. Abstract

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About the Author:

Dr. Anton Helman is an Emergency Physician at North York General in Toronto. He is an Assistant Professor at the University of Toronto, Division of Emergency Medicine and the Education Innovation Lead at the Schwartz-Reisman Emergency Medicine Instititute. He is the founder, editor-in-chief and host of Emergency Medicine Cases.

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