Abstracts

Non Convulsive Status Epilepticus (NCSE) assembles different electrographic and clinical syndromes. Although consciousness impairment is its outstanding feature, several other manifestations such as behavioral and cognitive changes, turns it difficult to diagnose. Due to this pleomorfism, great knowledge of its clinical presentation and high suspicious index is mandatory for prompt diagnosis., Records of patients with diagnosis of Status Epilepticus admitted into our center between 1996 and 2005 were reviewed. According to clinical and electrographic criteria, cases of NCSE were selected. Semiology, demographic data, aetiology, referral latencies and delays in diagnosis, treatment given and mortality were considered and submitted to statistical analysis., 63 patients were included, 3 of them presented more than 1 NCSE, totaling 68 NCSE.
The study group mean age was 57 ([plusmn]21), in it 35 patients were female.
Main presenting features were: consciousness impairment, confusion, behavioral changes and prolonged postictal state.
NCSE were classified as acute symptomatic: 26 cases, of remote aetiology: 30 cases and idiopathic or cryptogenic: 12 cases.
Mean referral latency was 65 hours (few minutes to 1 month).
On admission into our center, suspicious of NCSE arouse: immediately in 54 cases (79,41%), in 9 between 24 and 72 hours and in 5 cases around 96 hours (due to time required to rule out other aetiologies related to history of dementia, stroke, aphasia and psychiatric problems of these patients).
Time to control status after treatment started, was 24 hours. The larger delay in referral the longer the time to control status (p= 0.0005). 11 cases were classified as refractory.
Five patients died (7,3% of the study group). 4 deaths were related to the underlying disease.
While new onset NCSE were 38 cases (with a mean age of 61.2[plusmn]21.3), NCSE among epileptic patients resulted in 25 cases (mean age: 50.8[plusmn]18.4); (difference in ages between these sub-groups determined: p= 0.03). Non epileptic patients revealed longer delays when looking for medical intervention; and among them NCSE of acute symptomatic aetiology was more frequent (p=0.003)., Our study population represents one of the largest groups when considering prior reports in the literature.
Two main pieces of conclusions could be obtained from its analysis:
In first place: Considerable delays in referral were observed probably due to confusing heterogeneous clinical presentation; this determined longer times to control status. Low mortality rate could be related to early diagnosis and few refractory cases.
Secondly: in our study population NCSE appeared [ldquo]de novo[rdquo] mainly among older patients and specially related to an underlying acute process. Absence of history of epilepsy resulted in longer delays in looking for medical help.
We emphasize that: due to its potential control with prompt treatment and because of its heterogeneous presentation, high suspicious index could improve outcome of NCSE.,