INCONSISTENCY OF MENTAL STATUS EXAMINATION WHEN DIAGNOSING NONCONVULSIVE STATUS EPILEPTICUS
Abstract number :
3.107
Submission category :
Year :
2002
Submission ID :
3478
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
Bassel Shneker, Mark Quigg, Nathan Fountain. F.E.Dreifuss Comprehensive Epilepsy Program, Department of Neurology, University of Virginia, Charlottesville, VA
RATIONALE: Nonconvulsive status epilepticus (NCSE) is often difficult to diagnose, even with benzodiazepine (BZD) injection, because mental status improvement may be subtle and can be misinterpreted if systematic testing is not performed, or if different tasks are presented to the patient before and after administration of BZD. We hypothesized that consistent mental status (MS) testing is not performed systematically before and after BZD administration during EEG in patients who are suspected of having NCSE.
METHODS: We retrospectively reviewed EEG tracings in 14 patients who clinically and electrographically met the diagnosis of NCSE, who also received BZD to help establish the diagnosis. Clinical and EEG improvement were not required for this review. We collected the type of EEG discharge (spike-wave vs nonspike-wave), location (generalized vs lateralized or localized), type of BZD administered, clinical and EEG response (complete, partial, no response), and number of tasks that were presented to patients before and after BZD administration.
RESULTS: Of the 14 patients, 43% had spike-wave discharges on EEG and 78% had generalizeddischarges. BZD administered included; diazepam in 11, lorazepam in 2, and midazolam in 1. 50% had complete EEG response and 36% had partial response. 43% had complete clinical response and 28% had partial response. On average 2.7 (range 0- 9) tasks were presented to patients prior to BZD administration, and 3.4 tasks (range 0-9) after administration. On average, 55% of the tasks that were presented to patients prior to BZD administration were presented afterwards. On one occasion the person who presented the tasks prior to BZD administration was different from the person who did that after the administration.
CONCLUSIONS: Casual MS testing in the evaluation of NCSE is often not consistent or systematic, which raises the possibility that [dsquote]partial[dsquote] improvement in MS may not be appreciated after BZD administration. MS testing during the evaluation of NCSE should be detailed and consistent before and after BZD administration, such as with a standardized examination.