Psychiatric manifestations of nonconvulsive status epilepticus.
ABSTRACT Nonconvulsive status epilepticus (NCSE) is clinically characterized by altered mental status and the diagnosis is confirmed by electroencephalography. Absence status (AS) and complex partial status (CPS) are the two primary types of NCSE. Patients in NCSE may exhibit a wide range of clinical presentations including subtle memory deficits, bizarre behavior, psychosis, or coma. While prognosis is dependent on the underlying etiology and possibly related to duration of the event, there is limited research in this area. Treatment focuses on correcting underlying pathologic abnormalities such as hyponatremia or drug toxicity, and initiating pharmacologic therapy. The benzodiazepines are considered the first line treatment for both AS and CPS.
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ABSTRACT: To gain new insights into the clinical presentation, causes, treatment and prognosis of epilepsia partialis continua (EPC), and to develop hypotheses to be tested in a prospective investigation. In this retrospective multicenter study, all cases were included that fulfilled these criteria: constantly repeated fragments of epileptic seizures, with preserved consciousness, lasting ≥ 1 h and representing locally restricted motor or sensory epileptic activity. Single episodes were included when they lasted for a minimum of 1 day. EPC with Rasmussen syndrome and acute stroke were excluded. Three time courses with two subtypes each were distinguished, that is, EPC as a solitary event (de novo or in preexistent epilepsy); chronic repetitive nonprogressive EPC (with frequent or rare episodes); and chronic persistent nonprogressive EPC (primarily or evolving out of an episodic course). These were unrelated to etiologies (morphologic lesions 34%, inflammatory 29%, systemic disorders 9%, idiopathic 5%, unknown 23%). Precipitation and inhibition of seizures is a frequent feature of EPC. Levetiracetam and topiramate have improved the possibilities for pharmacotherapy. Topiramate seems to be particularly effective with dysontogenetic etiologies. The existence of several clearly distinct courses of nonprogressive EPC is a new finding. These distinctions will be further investigated in a prospective study with precise protocols for electroencephalography (EEG), imaging, and other studies. This should better establish the relation of motor and somatosensory EPC; further clarify the relations, pathogenesis, and significance of the different types and their etiologies; and possibly identify more semiologic variants. It should also provide more precise knowledge about therapy and modification of ictogenesis by external stimuli.Epilepsia 02/2011; 52(6):1168-76. DOI:10.1111/j.1528-1167.2010.02974.x · 4.58 Impact Factor
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ABSTRACT: Temporal lobe epilepsy (TLE), a subset of the seizure disorder family, represents a complex neuropsychiatric illness, where the neurological presentation may be complemented by varying severity of affective, behavioral, psychotic, or personality abnormalities, which, in turn, may not only lead to misdiagnosis, but also affect the management. This paper outlines a spectrum of mental health presentations, including psychosis, mood, anxiety, panic, and dissociative states, associated with epilepsy that make the correct diagnosis a challenge.01/2012; 2012:163731. DOI:10.1155/2012/163731
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ABSTRACT: Nonconvulsive status epilepticus (NCSE) has different clinical presentations, from minimal confusion to bizarre behavioral manifestations, psychosis or coma. As a result, patients can sometimes be misdiagnosed and labeled as psychiatric cases. The patient was alert and disoriented in time, with disconnection episodes, generalized slowness, slow mental response, faltering language and slow answers. A differential diagnosis between dissociative status and NCSE was proposed. The physical and neurological examinations were normal. The cranial CT scan findings were normal. Only the EEG provided the definitive diagnostic data, consisting of generalized spike and wave discharges of 2-3 Hz against a desynchronized background. Diagnosis of NCSE requires the availability of an EEG. Often patients are on the border between medical conditions and mental disorders. Observation of the disease evolution and an open-minded attitude of physicians are necessary for the correct diagnosis and treatment.Actas espanolas de psiquiatria 03/2012; 40(2):93-6. · 0.76 Impact Factor