Comatose nonconvulsive status epilepticus (NCSE) is a condition characterized by a coma state accompanied by continuous or periodic epileptiform brain activity, as seen on EEG. The diagnosis requires both clinical assessment showing a comatose state as well as EEG confirmation of epileptiform discharges. Treatment involves administering anti-epileptic drugs (AEDs) and continuing the treatment if it leads to improvements in both the EEG findings and clinical condition. However, AEDs should not be continued if EEG abnormalities improve without accompanying clinical recovery, as clearing of EEG patterns alone may not indicate resolution of the underlying condition.

1. Comatose NCSE
ADE WIJAYA, MD – FEBRUARY 2018

2. Introduction
•Nonconvulsive status epilepticus encompasses a wide range of conditions with “reduced or
altered consciousness, behavioral, vegetative, or merely subjective symptoms, such as auras, but
without major convulsive movements”
• Comatose NCSE: A condition with coma accompanied by continuous or periodic epileptiform
discharges with or without minor motor activity
• EEG confirms the clinical diagnosis of NCSE
Bauer, G., & Trinka, E. (2010). Nonconvulsive status epilepticus and coma. Epilepsia, 51(2), 177-190.
Drislane, F.W. Presentation, evaluation, and treatment of nonconvulsive status epilepticus.Epilepsy Behav. 2000; 1: 301–314
Fujikawa, D.G. The two faces of electrographic status epilepticus: the walking wounded and the ictally comatose. in: C.T.D.M. Wasterlain (Ed.) Status epilepticus; mechanisms and management. MIT press, Cambridge (MS); 2006: 109–112

3. Trinka, E., & Leitinger, M. (2015). Which EEG patterns in coma are nonconvulsive status epilepticus?. Epilepsy & behavior, 49, 203-222.

4. Bauer, G., & Trinka, E. (2010). Nonconvulsive status epilepticus and coma. Epilepsia, 51(2), 177-190.

5. Trinka, E., & Leitinger, M. (2015). Which EEG patterns in coma are nonconvulsive status epilepticus?. Epilepsy & behavior, 49, 203-222.
Bauer, G., & Trinka, E. (2010). Nonconvulsive status epilepticus and coma. Epilepsia, 51(2), 177-190.

6. Beniczky, S., Hirsch, L.J., Kaplan, P.W., Pressler, R., Bauer, G., Aurlien, H. et al. Unified EEG terminology and criteria for nonconvulsive status epilepticus. Epilepsia. 2013; 54: 28–29
SALZBURG CRITERIA

7. Trinka, E., & Leitinger, M. (2015). Which EEG patterns in coma are nonconvulsive status epilepticus?. Epilepsy & behavior, 49, 203-222.

8. Trinka, E., & Leitinger, M. (2015). Which EEG patterns in coma are nonconvulsive status epilepticus?. Epilepsy & behavior, 49, 203-222.

9. Management
• Pragmatically, we would propose a treatment trial with sufficient intravenous doses of an AED
after exclusion of intoxications. If the response leads to electrographic and clinical improvement,
the AED treatment should be continued (Drislane & Schomer, 1994a)
• A cessation of epileptiform EEG abnormalities without any clinical improvement can be
observed after application of AEDs, especially in cases with triphasic waves (Fountain &
Waldman, 2001). Clearing of EEG activities is transient in many cases and, if not followed by
clinical recovery, there is no reason to continue a potentially harmful sedation

10. Summary
• Comatose NCSE: A condition with coma accompanied by continuous or periodic epileptiform
discharges with or without minor motor activity
• Clinical + EEG
• Salzburg criteria
• If the response leads to electrographic and clinical improvement, the AED treatment should be
continued
• A cessation of epileptiform EEG abnormalities without any clinical improvement can be
observed after application of AEDs, especially in cases with triphasic waves. Clearing of EEG
activities is transient in many cases and, if not followed by clinical recovery, there is no reason to
continue a potentially harmful sedation

11. THANK YOU