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Minerva Psichiatrica 2009 December;50(4):319-28


language: English

The spectrum of primary psychiatric manifestations of non-convulsive status epilepticus: the status of the associations

Galimi R.

Neurological Department, Health Local Unit of Valtellina and Valchiavenna Sondalo Hospital, Sondalo, Sondrio, Italy


Altered mental status (AMS) is a fairly common reason for patients to visit the emergency department (ED). AMS is a symptom complex that continually poses a great challenge in the ED. Non-convulsive statua epilepticus (NCSE) includes all types of status epilepticus (SE) that have no (or only subtle) motor manifestations. Absence status (AS) and complex partial status (CPS) are the two primary types of NCSE. NCSE is protean in its presentation is often misdiagnosed. There is yet no universally accepted definition or classification that encompasses all subtypes or electroclinical scenarios. Mistaken diagnosis and delayed treatment increase the risk of neurologic damage, so recognizing NCSE symptoms early is important. Although strong epidemiological data are lacking, NCSE constitutes about 25-50% of all cases of SE. NCSE is generally characterized as absence SE or complex-partial SE. This illness needs to be seriously considered in the differential diagnosis of severely ill patients with atypical psychoses refractory to traditional treatments. Clinically, there is considerable overlap. Patients in NCSE may suffer of subtle memory deficits, psychosis, coma, or bizarre behavior . Bizarre behaviors may occur, including agitation, inappropriate laughter or crying, staring, oral automatisms, and rigidity. Behaviors may lead to a misdiagnosis of psychiatric disease. In most cases diagnosis can be established using an electroencephalogram (EEG), sometimes requiring continuous monitoring. The diagnosis of these conditions is critically dependent on EEG. Without the EEG, these patients are often thought to have functional disorders. In this paper, the author reviews the available literature relevant to the clinical phenomenology and treatment of this topic. This article describes neuropschyatric manifestation, the differential diagnosis by reviewing clinical symptoms, and treatment used to rapidly halt ictal activity. The benzodiazepines are considered the first line treatment for both AS and CPS. Benzodiazepines such as lorazepam are the drugs of first choice for alcohol and benzodiazepine withdrawal NCSE. Overall, further work is needed to better define NCSE.

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