Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Diagnosis and management of nonconvulsive status epilepticus in children

Nature Clinical Practice Neurology volume 3, pages 505–516 (2007)Cite this article

Abstract

Nonconvulsive status epilepticus (NCSE) encompasses a wide range of diagnoses with variable outcomes and treatment recommendations. In children, NCSE can be observed in various conditions, including acute neurological injuries, specific childhood epilepsy syndromes and other neurological conditions, and can also be observed in individuals with learning difficulties. NCSE in children is thought to be under-recognized, and further studies examining the electrographic characteristics of very young children in NCSE would aid the prompt recognition of additional patients. Some subtypes of NCSE are probably more harmful than others, and long-term prospective studies are needed to evaluate the damaging potential of NCSE itself as opposed to that of the underlying circumstances in which it occurs. Specific data in childhood are clearly lacking, but extrapolation from adult studies indicates that aggressive treatment is most warranted in comatose patients. By contrast, a cautious approach seems to be indicated for absence status epilepticus, complex partial status epilepticus and electrical status epilepticus during sleep.

Key Points

  • Nonconvulsive status epilepticus (NCSE) has been defined as a cognitive or behavioral change that lasts for at least 30 minutes, with evidence of seizures on electroencephalogram

  • The diagnosis of NCSE is difficult and requires a high index of suspicion; the condition is probably under-recognized

  • The variation in the conditions encompassed by the term NCSE and the lack of agreement on diagnostic criteria, such as electroencephalographic features, contribute to its problematic identification

  • NCSE is notoriously observed in various childhood epilepsy syndromes, encephalopathies and acute conditions

  • Clear data regarding diagnosis, treatment and outcome of NCSE are particularly wanting in children

  • Further studies analyzing the electroencephalographic features and clinical presentation of NCSE in children, especially the very young, are needed

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Electroencephalographic features of absence status epilepticus
Figure 2: Periodic discharges of nonconvulsive status epilepticus following convulsive status epilepticus
Figure 3: Periodic lateralized epileptiform discharges in nonconvulsive status epilepticus

Similar content being viewed by others

References

  1. Commission on Terminology of the International League against Epilepsy (1964) A proposed international classification of epileptic seizures. Epilepsia 157: 297–306

  2. Meldrum BS and Brierley JB (1973) Prolonged epileptic seizures in primates: ischemic cell change and its relation to ictal physiological events. Arch Neurol 28: 10–17

    Article  CAS  Google Scholar 

  3. Lowenstein DH (1999) Status epilepticus: an overview of the clinical problem. Epilepsia 40 (Suppl 1): S3–S8

    Article  Google Scholar 

  4. International League against Epilepsy: Glossary of descriptive terminology for ictal semiology [http://www.ilae-epilepsy.org/Visitors/Centre/ctf/glossary.cfm]

  5. Kaplan PW (2000) Prognosis in nonconvulsive status epilepticus. Epileptic Disord 2: 185–193

    CAS  PubMed  Google Scholar 

  6. Walker MC (2001) Diagnosis and treatment of nonconvulsive status epilepticus. CNS Drugs 15: 931–939

    Article  CAS  Google Scholar 

  7. Husain AM et al. (1999) Generalized periodic epileptiform discharges: etiologies, relationship to status epilepticus, and prognosis. J Clin Neurophysiol 16: 51–58

    Article  CAS  Google Scholar 

  8. Walker M et al. (2005) Nonconvulsive status epilepticus: Epilepsy Research Foundation workshop reports. Epileptic Disord 7: 253–296

    PubMed  Google Scholar 

  9. Walker MC (2003) Status epilepticus on the intensive care unit. J Neurol 250: 401–406

    Article  Google Scholar 

  10. Shorvon S (2001) The management of status epilepticus. J Neurol Neurosurg Psychiatry 70 (Suppl 2): II22–II27

    PubMed  PubMed Central  Google Scholar 

  11. Williamson PD et al. (1985) Complex partial seizures of frontal lobe origin. Ann Neurol 18: 497–504

    Article  CAS  Google Scholar 

  12. Cascino GD (1993) Nonconvulsive status epilepticus in adults and children. Epilepsia 34 (Suppl 1): S21–S28

    Article  Google Scholar 

  13. Krumholz A (1999) Epidemiology and evidence for morbidity of nonconvulsive status epilepticus. J Clin Neurophysiol 16: 314–322

    Article  CAS  Google Scholar 

  14. Arzimanoglou A et al. (2004) Status epilepticus. In Aicardi's Epilepsy in Children, edn 3, 241–261 (Eds Arzimanoglou A et al.) Philadelphia: Lippincott Williams & Wilkins

    Google Scholar 

  15. Scholtes FB et al. (2005) Cognitive deterioration and electrical status epilepticus during slow sleep. Epilepsy Behav 6: 167–173

    Article  CAS  Google Scholar 

  16. Dirik E et al. (2006) Nonconvulsive status epilepticus and neurodevelopmental delay. Pediatr Neurol 35: 209–212

    Article  Google Scholar 

  17. Towne AR et al. (2000) Prevalence of nonconvulsive status epilepticus in comatose patients. Neurology 54: 340–345

    Article  CAS  Google Scholar 

  18. Young GB et al. (1996) An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology 47: 83–89

    Article  CAS  Google Scholar 

  19. Lowenstein DH and Aminoff MJ (1992) Clinical and EEG features of status epilepticus in comatose patients. Neurology 42: 100–104

    Article  CAS  Google Scholar 

  20. DeLorenzo RJ et al. (1998) Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia 39: 833–840

    Article  CAS  Google Scholar 

  21. Riviello JJ Jr et al. (2006) Practice parameter: diagnostic assessment of the child with status epilepticus (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 67: 1542–1550

    Article  Google Scholar 

  22. Tay SK et al. (2006) Nonconvulsive status epilepticus in children: clinical and EEG characteristics. Epilepsia 47: 1504–1509

    Article  Google Scholar 

  23. Hyllienmark L and Amark P (2007) Continuous EEG monitoring in a paediatric intensive care unit. Eur J Paediatr Neurol 11: 70–75

    Article  Google Scholar 

  24. Jette N et al. (2006) Frequency and predictors of nonconvulsive seizures during continuous electroencephalographic monitoring in critically ill children. Arch Neurol 63: 1750–1755

    Article  Google Scholar 

  25. Hosain SA et al. (2005) Electroencephalographic patterns in unresponsive pediatric patients. Pediatr Neurol 32: 162–165

    Article  Google Scholar 

  26. Saengpattrachai M et al. (2006) Nonconvulsive seizures in the pediatric intensive care unit: etiology, EEG, and brain imaging findings. Epilepsia 47: 1510–1518

    Article  Google Scholar 

  27. Drislane FW (1999) Evidence against permanent neurologic damage from nonconvulsive status epilepticus. J Clin Neurophysiol 16: 323–331

    Article  CAS  Google Scholar 

  28. Chong DJ and Hirsch LJ (2005) Which EEG patterns warrant treatment in the critically ill? Reviewing the evidence for treatment of periodic epileptiform discharges and related patterns. J Clin Neurophysiol 22: 79–91

    Article  Google Scholar 

  29. Snodgrass SM et al. (1989) Clinical significance of periodic lateralized epileptiform discharges: relationship with status epilepticus. J Clin Neurophysiol 6: 159–172

    Article  CAS  Google Scholar 

  30. Terzano MG et al. (1986) Confusional states with periodic lateralized epileptiform discharges (PLEDs): a peculiar epileptic syndrome in the elderly. Epilepsia 27: 446–457

    Article  CAS  Google Scholar 

  31. Assal F et al. (2001) SPECT in periodic lateralized epileptiform discharges (PLEDs): a form of partial status epilepticus? Seizure 10: 260–265

    Article  CAS  Google Scholar 

  32. Westmoreland BF et al. (1986) Chronic periodic lateralized epileptiform discharges. Arch Neurol 43: 494–496

    Article  CAS  Google Scholar 

  33. Hirsch LJ and Claassen J (2002) The current state of treatment of status epilepticus. Curr Neurol Neurosci Rep 2: 345–356

    Article  Google Scholar 

  34. PeBenito R and Cracco JB (1979) Periodic lateralized epileptiform discharges in infants and children. Ann Neurol 6: 47–50

    Article  CAS  Google Scholar 

  35. Aydin OF et al. (2006) Nonconvulsive status epilepticus on electroencephalography in a case with subacute sclerosing panencephalitis. J Child Neurol 21: 256–260

    Article  Google Scholar 

  36. Jette N et al. (2006) Tiagabine-induced nonconvulsive status epilepticus in an adolescent without epilepsy. Neurology 67: 1514–1515

    Article  Google Scholar 

  37. Atefy R and Tettenborn B (2005) Nonconvulsive status epilepticus on treatment with levetiracetam. Epilepsy Behav 6: 613–616

    Article  Google Scholar 

  38. Nakken KO et al. (2003) A paradoxical effect of levetiracetam may be seen in both children and adults with refractory epilepsy. Seizure 12: 42–46

    Article  Google Scholar 

  39. Hasan M et al. (2006) Recurrent absence status epilepticus (spike-and-wave stupor) associated with lamotrigine therapy. J Child Neurol 21: 807–809

    Article  Google Scholar 

  40. Shahar E et al. (2002) Valproic acid therapy inducing absence status evolving into generalized seizures. Pediatr Neurol 26: 402–404

    Article  Google Scholar 

  41. Mangano S et al. (2003) Non-convulsive status epilepticus associated with tiagabine in a pediatric patient. Brain Dev 25: 518–521

    Article  Google Scholar 

  42. Skardoutsou A et al. (2003) Non-convulsive status epilepticus associated with tiagabine therapy in children. Seizure 12: 599–601

    Article  Google Scholar 

  43. Tassinari CA et al. (1972) Tonic status epilepticus precipitated by intravenous benzodiazepine in five patients with Lennox–Gastaut syndrome. Epilepsia 13: 421–435

    Article  CAS  Google Scholar 

  44. Shinnar S et al. (2001) Status epilepticus and tiagabine therapy: review of safety data and epidemiologic comparisons. Epilepsia 42: 372–379

    Article  CAS  Google Scholar 

  45. Dravet C et al. (2005) Severe myoclonic epilepsy in infancy: Dravet syndrome. Adv Neurol 95: 71–102

    PubMed  Google Scholar 

  46. Wakai S et al. (1996) “Obtundation status (Dravet)” caused by complex partial status epilepticus in a patient with severe myoclonic epilepsy in infancy. Epilepsia 37: 1020–1022

    Article  CAS  Google Scholar 

  47. Neubauer BA et al. (2005) Myoclonic-astatic epilepsy of early childhood: definition, course, nosography, and genetics. Adv Neurol 95: 147–155

    CAS  PubMed  Google Scholar 

  48. Coppola G et al. (1995) Migrating partial seizures in infancy: a malignant disorder with developmental arrest. Epilepsia 36: 1017–1024

    Article  CAS  Google Scholar 

  49. Dalla Bernardina B et al. (2005) Myoclonic status in nonprogressive encephalopathies. Adv Neurol 95: 59–70

    PubMed  Google Scholar 

  50. Inoue Y et al. (1997) Ring chromosome 20 and nonconvulsive status epilepticus: a new epileptic syndrome. Brain 120: 939–953

    Article  Google Scholar 

  51. Augustijn PB et al. (2001) Ring chromosome 20 epilepsy syndrome in children: electroclinical features. Neurology 57: 1108–1111

    Article  CAS  Google Scholar 

  52. Bertram EH et al. (1990) The hippocampus in experimental chronic epilepsy: a morphometric analysis. Ann Neurol 27: 43–48

    Article  CAS  Google Scholar 

  53. Lothman E (1990) The biochemical basis and pathophysiology of status epilepticus. Neurology 40 (Suppl 2): S13–S23

    Google Scholar 

  54. Krsek P et al. (2004) Long-term behavioral and morphological consequences of nonconvulsive status epilepticus in rats. Epilepsy Behav 5: 180–191

    Article  Google Scholar 

  55. Drislane FW (1999) Evidence against permanent neurologic damage from nonconvulsive status epilepticus. J Clin Neurophysiol 16: 323–331

    Article  CAS  Google Scholar 

  56. Krumholz A et al. (1995) Complex partial status epilepticus accompanied by serious morbidity and mortality. Neurology 45: 1499–1504

    Article  CAS  Google Scholar 

  57. Cockerell OC et al. (1994) Complex partial status epilepticus: a recurrent problem. J Neurol Neurosurg Psychiatry 57: 835–837

    Article  CAS  Google Scholar 

  58. Shirasaka Y (2002) Lack of neuronal damage in atypical absence status epilepticus. Epilepsia 43: 1498–1501

    Article  Google Scholar 

  59. Van Hirtum-Das M et al. (2006) Children with ESES: variability in the syndrome. Epilepsy Res 70 (Suppl 1): S248–S258

    Article  Google Scholar 

  60. Uberall MA et al. (2000) Intravenous valproate in pediatric epilepsy patients with refractory status epilepticus. Neurology 54: 2188–2189

    Article  CAS  Google Scholar 

  61. Hodges BM and Mazur JE (2001) Intravenous valproate in status epilepticus. Ann Pharmacother 35: 1465–1470

    Article  CAS  Google Scholar 

  62. Morrell F et al. (1995) Landau–Kleffner syndrome: treatment with subpial intracortical transection. Brain 118: 1529–1546

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. CM Korff is a Pediatric Neurologist at the Children's Hospital, Geneva, Switzerland.,

    Christian M Korff

  2. DR Nordli Jr is Associate Professor of Neurology and Pediatrics, and Lorna S and James P Langdon Chair in Pediatric Epilepsy at Northwestern University Medical School, and Director of the Epilepsy Center at the Children's Memorial Hospital, Chicago, IL, USA.,

    Douglas R Nordli Jr

Authors
  1. Christian M Korff
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Douglas R Nordli Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christian M Korff.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Korff, C., Nordli, D. Diagnosis and management of nonconvulsive status epilepticus in children. Nat Rev Neurol 3, 505–516 (2007). https://doi.org/10.1038/ncpneuro0605

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpneuro0605

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing