Epidemiology, diagnosis, and management of nonconvulsive status epilepticus: opening Pandora’s box

Nonconvulsive status epilepticus (NCSE) is a state of continuous seizure activity for at least 30 minutes, with cognitive or behavioral changes. It may be classified according to EEG evidence of focal or generalized epileptic activity, but may be further categorized by etiology and level of consciousness, both with prognostic weight. There have been several attempts to define the electrographic characteristics of NCSE. Clinical challenges arise from the frequent subtle clinical manifestations, the need for EEG confirmation of ongoing epileptic activity, and physicians’ lack of awareness of the possibility of NCSE. This underdiagnosis may have deleterious consequences. This review encompasses epidemiologic, clinical, diagnostic, and prognostic aspects of NCSE in adults, and delineates strategies for management.