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Emerg Med Pract. 2019 Oct;21(10):1-24. Epub 2019 Oct 1.

Nonconvulsive status epilepticus: overlooked and undertreated.

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Assistant Professor of Emergency Medicine & Critical Care, Florida International University, Miami, FL; Clinical Assistant Professor of Emergency Medicine, NYU, New York, NY; Clerkship Director, Emergency Medicine, Aventura Hospital & Medical Center, Aventura, FL.
Attending Physician, Memorial Regional Hospital, Hollywood, FL.
Attending Physician, Southern California Permanente Medical Group, Department of Emergency Medicine, Kaiser Permanente Woodland Hills Medical Center, Woodland Hills, CA.


Nonconvulsive status epilepticus (NCSE) is characterized by persistent change in mental status from baseline lasting more than 5 minutes, generally with epileptiform activity seen on EEG monitoring and subtle or no motor abnormalities. NCSE can be a difficult diagnosis to make in the emergency department setting, but the key to diagnosis is a high index of suspicion coupled with rapid initiation of continuous EEG and early involvement of neurology. Benzodiazepines are the mainstay of first-line therapy, with antiepileptic drugs and anesthetics as second- and third-line therapies, respectively. The few established guidelines on the treatment of NCSE are highly variable, and the objective of this comprehensive review is to create a standardized evidence-based protocol for the diagnosis and treatment of NCSE.


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