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Nat Rev Neurol. 2016 May;12(5):281-93. doi: 10.1038/nrneurol.2016.45. Epub 2016 Apr 11.

Nonconvulsive status epilepticus in adults - insights into the invisible.

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Clinic for Intensive Care Medicine, University Hospital Basel, Petersgraben 4, Ch-4031 Basel, Switzerland.
Department of Neurology and Intensive Care Unit, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
Department of Neurology, Johns Hopkins Bayview Medical Center, 301 Building 4940 Eastern Avenue, Baltimore, Maryland 21224, USA.


Nonconvulsive status epilepticus (NCSE) is a state of continuous or repetitive seizures without convulsions. Owing to the nonspecific symptoms and considerable morbidity and mortality associated with NCSE, clinical research has focused on early diagnosis, risk stratification and seizure termination. The subtle symptoms and the necessity for electroencephalographic confirmation of seizures result in under-diagnosis with deleterious consequences. The introduction of continuous EEG to clinical practice, and the characterization of electrographic criteria have delineated a number of NCSE types that are associated with different prognoses in several clinical settings. Epidemiological studies have uncovered risk factors for NCSE; knowledge of these factors, together with particular clinical characteristics and EEG observations, enables tailored treatment. Despite these advances, NCSE can be refractory to antiepileptic drugs, necessitating further escalation of treatment. The presumptive escalation to anaesthetics, however, has recently been questioned owing to an association with increased mortality. This Review compiles epidemiological, clinical and diagnostic aspects of NCSE, and considers current treatment options and prognosis.

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