Skip to main content
SpringerLink
Log in

Status Epilepticus in Adults

  • Chapter
Clinical Electroencephalography

  • 3202 Accesses

Abstract

In electroencephalography books, relative significance is given to “status epilepticus” (SE), maybe because of the idea that it could only be a simple repetition of seizures in a very short time from one another. Actually, at least two factors contribute making the EEG patterns of SE much more complex: the first is the overlapping of the transients related to the seizures with those related to underlying disease, and the second is the EEG modification related to a sustained or prolonged status epilepticus. The EEG of the SE can thus follow its graphic expression which is different from that of single seizures repeated over time, coming up to express critical patterns that are not always easily recognizable. The elements of pathophysiology and clinical electroencephalographic practice show that the SE is a dynamic pathological process that expresses itself in a different manner from patient to patient depending on its etiology, duration, topographic extension, clinical manifestation, and therapeutic interventions that are carried out. The proposed classification of SE in 2015 (Trinka et al., Epilepsia 56(10):1515–23, 2015) establishes the importance of EEG in the diagnosis and management of the SE by including the EEG axial description to define a correct classification of the patient.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hesdorffer DC, Logroscino G, Cascino G, et al. Incidence of status epilepticus in Rochester, Minnesota, 1965–1984. Neurology. 1998;50(3):735–41.

    CAS  PubMed  Google Scholar 

  2. Coeytaux A, Jallon P, Galobardes B. Incidence of status epilepticus in French-speaking Switzerland: (EPISTAR). Neurology. 2000;55(5):693–7.

    CAS  PubMed  Google Scholar 

  3. DeLorenzo RJ, Pellock JM, Towne AR, et al. Epidemiology of status epilepticus. J Clin Neurophysiol. 1996;13(5):458.

    Google Scholar 

  4. Knake S, Rosenow F, Vescovi M, et al. Incidence of status epilepticus in adults in Germany: a prospective, population-based study. Status Epilepticus Study Group Hessen (SESGH). Epilepsia. 2001;42(6):714–8.

    CAS  PubMed  Google Scholar 

  5. Vignatelli L, Tonon C, D’Alessandro R. Bologna Group for the Study of Status Epilepticus. Incidence and short-term prognosis of status epilepticus in adults in Bologna, Italy. Epilepsia. 2003;44(7):964–8.

    PubMed  Google Scholar 

  6. Waterhouse EJ, DeLorenzo RJ. Status epilepticus in older patients: epidemiology and treatment options. Drugs Aging. 2001;18(2):133–42.

    CAS  PubMed  Google Scholar 

  7. Hauser WA. Status epilepticus: epidemiologic considerations. Neurology. 1990;40(5 Suppl 2):9–13.

    CAS  PubMed  Google Scholar 

  8. Towne AR, Pellock JM, Ko D, et al. Determinants of mortality in status epilepticus. Epilepsia. 1994;35:27–34.

    CAS  PubMed  Google Scholar 

  9. Shneker BF, Fountain NB. Assessment of acute morbidity and mortality in non status epilepticus. Neurology. 2003;61:1066–73.

    PubMed  Google Scholar 

  10. Rossetti AO, Logroscino G, Bromfield EB. A clinical score for prognosis of status epilepticus in adult. Neurology. 2006;66:1736–8.

    PubMed  Google Scholar 

  11. Aminoff MJ, Simon RP. Status epilepticus. Causes, clinical features and consequences in 98 patients. Am J Med. 1980;69(5):657–66.

    CAS  PubMed  Google Scholar 

  12. Tan RY, Neligan A, Shorvon SD. The uncommon causes of status epilepticus. Epilepsy Res. 2010;91:111–22.

    CAS  PubMed  Google Scholar 

  13. Dobesberger J, Ristić AJ, Walser G, et al. Duration of focal complex, secondarily generalized tonic–clonic, and primarily generalized tonic–clonic seizures: a video-EEG analysis. Epilepsy Behav. 2015;49:111–7.

    PubMed  Google Scholar 

  14. Treatment of convulsive status epilepticus. Recommendations of the epilepsy foundation of America’s working group on status epilepticus. JAMA. 1993;270(7):854–9.

    Google Scholar 

  15. Trinka E, Cock H, Hesdorffer D, et al. A definition and classification of status epilepticus – report of the ILAE task force on classification of status Epilepticus. Epilepsia. 2015;56(10):1515–23.

    PubMed  Google Scholar 

  16. Gastaut H, Tassinari C. Status epilepticus. In: Redmond A, editor. Handbook of electroencephalography and clinical neurophysiology, vol. 13. Amsterdam: Elsevier; 1975. p. 39–45.

    Google Scholar 

  17. Shorvon S. Status epilepticus: its clinical features and treatment in children and adults. Cambridge: Cambridge University Press; 1994.

    Google Scholar 

  18. Treiman DM, Walton NY, Kendrick C. A progressive sequence of electroencephalographic changes during generalised convulsive status epilepticus. Epilepsy Res. 1990;5:49–60.

    CAS  PubMed  Google Scholar 

  19. Lothman EW. The biochemical basis and pathophysiology of status epilepticus. Neurology. 1990;40(Supp1 2):13–23.

    CAS  PubMed  Google Scholar 

  20. Florea B, Beniczky SA, Demény H. Semiology of subtle motor phenomena in critically ill patients. Seizure. 2017;48:33–5.

    PubMed  Google Scholar 

  21. Kobayashi E, Thomas P, Andermann F. Tonic status epilepticus in patients with idiopathic generalized epilepsy. Epileptic Disord. 2005;7(4):327–31.

    PubMed  Google Scholar 

  22. Mameniškienė R, Wolf P. Epilepsia partialis continua: a review. Seizure. 2017;44:74–80.

    PubMed  Google Scholar 

  23. Gastaut H. Aphasia: the sole manifestation of focal status epilepticus. Neurology. 1979;29(12):1638.

    CAS  PubMed  Google Scholar 

  24. Wells CR, Labar DR, Solomon GE. Aphasia as the sole manifestation of simple partial status epilepticus. Epilepsia. 1992;33(1):84–7.

    CAS  PubMed  Google Scholar 

  25. DeToledo JC, Minagar A, Lowe MR. Persisting aphasia as the sole manifestation of partial status epilepticus. Clin Neurol Neurosurg. 2000;102(3):144–8.

    CAS  PubMed  Google Scholar 

  26. Thomas P, Kullmann B, Chatel M. Status epilepticus with aphasic manifestation. Rev Neurol. 1991;147(3):246–50.

    CAS  PubMed  Google Scholar 

  27. Grimes DA, Guberman A. De novo aphasic status epilepticus. Epilepsia. 1997;38(8):945–9.

    CAS  PubMed  Google Scholar 

  28. Herskovitz M, Schiller Y. Prolonged ictal aphasia: a diagnosis to consider. J Clin Neurosci. 2012;19(11):1605–6.

    PubMed  Google Scholar 

  29. Takaya S, Matsumoto R, Namiki C, et al. Frontal nonconvulsive status epilepticus manifesting somatic hallucinations. J Neurol Sci. 2005;234(1–2):25–9.

    PubMed  Google Scholar 

  30. Tiamkao S, Pratipanawatr T, Jitpimolmard S. Abdominal epilepsy: an uncommon of non-convulsive status epilepticus. J Med Assoc Thai. 2011;94(8):998–1001.

    PubMed  Google Scholar 

  31. Kaplan P. EEG criteria for nonconvulsive status epilepticus. Epilepsia. 2007;48(Suppl 8):39–41.

    PubMed  Google Scholar 

  32. Treiman DM, Delgado-Escueta AV. Complex partial status epilepticus. Adv Neurol. 1983;34:69–81.

    CAS  PubMed  Google Scholar 

  33. Granner MA, Lee S. Nonconvulsive status epilepticus: EEG annalysis in a large series. Epilepsia. 1994;35:42–7.

    CAS  PubMed  Google Scholar 

  34. Young GB, Jordan KG, Doig GS. An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology. 1996;47:83–9.

    CAS  PubMed  Google Scholar 

  35. Chong DJ, Hirsch LJ. Which EEG patterns warrant treatment in the critically ill? Reviewing the evidence for treatment of periodic epileptiform discharges and related patterns. Clin Neurophysiol. 2005;22(2):79–91.

    Google Scholar 

  36. Sutter R, Kaplan PW. Electroencephalographic criteria for nonconvulsive status epilepticus: synopsis and comprehensive survey. Epilepsia. 2012;53(Suppl 3):1–51.

    PubMed  Google Scholar 

  37. Beniczky S, Hirsch LJ, Kaplan PW, et al. Unified EEG terminology and criteria for nonconvulsive status epilepticus. Epilepsia. 2013;54(Suppl 6):28–9.

    PubMed  Google Scholar 

  38. Leitinger M, Beniczky S, Rohracher A, et al. Salzburg consensus criteria for non-convulsive status epilepticus: approach to clinical application. Epilepsy Behav. 2015;49:158–63.

    CAS  PubMed  Google Scholar 

  39. Leitinger M, Trinka E, et al. Diagnostic accuracy of the Salzburg EEG criteria for non-convulsive status epilepticus: a retrospective study. Lancet Neurol. 2016;15:1054–62.

    PubMed  Google Scholar 

  40. Walker M, Cross H, Smith S, et al. Nonconvulsive status epilepticus: Epilepsy Research Foundation workshop reports. Epileptic Disord. 2005;7(3):253–96.

    PubMed  Google Scholar 

  41. Hirsch LJ, Brenner RP, Drislane FW, et al. The ACNS subcommittee on research terminology for continuous EEG monitoring: proposed standardized terminology for rhythmic and periodic EEG patterns encountered in critically ill patients. J Clin Neurophysiol. 2005;22:128–35.

    PubMed  Google Scholar 

  42. Trinka E, Leitinger M. Which EEG patterns in coma are nonconvulsive status epilepticus? Epilepsy Behav. 2015;49:203–22.

    PubMed  Google Scholar 

  43. Brigo F. Intermittent rhythmic delta activity patterns. Epilepsy Behav. 2011;20:254–6.

    PubMed  Google Scholar 

  44. Gaspard N, Manganas L, Rampal N. Similarity of lateralized rhythmic delta activity to periodic lateralized epileptiform discharges in critically ill patients. JAMA Neurol. 2013;70(10):1288–95.

    PubMed  Google Scholar 

  45. Rodriguez Ruiz A, Vlachy J, Lee JW, et al. Association of periodic and rhythmic electroencephalographic patterns with seizures in critically ill patients. JAMA Neurol. 2017;74(2):181–8.

    PubMed  Google Scholar 

  46. Van Putten MJ, Hofmeijer J. Generalized periodic discharges: pathophysiology and clinical considerations. Epilepsy Behav. 2015;49:228–33.

    PubMed  Google Scholar 

  47. Bremer F. Considérations sur l’origine et la nature des ondes cérébrales. Electroencephalogr Clin Neurophysiol. 1949;1(2):177–93.

    CAS  PubMed  Google Scholar 

  48. Chatrian GE, Shaw CM, Leffman H. The significance of periodic lateralized epileptiform discharges in EEG: an electrographic, clinical and pathological study. Electroencephalogr Clin Neurophysiol. 1964;17:177–93.

    CAS  PubMed  Google Scholar 

  49. Brenner RP, Schaul N. Periodic EEG patterns: classification, clinical correlation, and pathophysiology. J Clin Neurophysiol. 1990;7(2):249–67.

    CAS  PubMed  Google Scholar 

  50. Snodgrass SM, Tsuburaya K, Ajmone-Marsan C. Clinical significance of periodic lateralized epileptiform discharges: relationship with status epilepticus. J Clin Neurophysiol. 1989;6(2):159–72.

    CAS  PubMed  Google Scholar 

  51. Raroque HG Jr, Purdy P. Lesion localization in periodic lateralized epileptiform discharges: gray or white matter. Epilepsia. 1995;36(1):58–62.

    PubMed  Google Scholar 

  52. Gurer G, Yemisci M, Saygi S, et al. Structural lesions in periodic lateralized epileptiform discharges (PLEDs). Clin EEG Neurosci. 2004;35(2):88–93.

    PubMed  Google Scholar 

  53. Pohlmann-Eden B, Hoch DB, Cochius JI, et al. Periodic lateralized epileptiform discharges a critical review. J Clin Neurophysiol. 1996;13(6):519–30.

    CAS  PubMed  Google Scholar 

  54. Baykan B, Kinay D, Gokyigit A, et al. Periodic lateralized epileptiform discharges: association with seizures. Seizure. 2000;9(6):402–6.

    CAS  PubMed  Google Scholar 

  55. Assal F, Papazyan JP, Slosman DO, et al. SPECT in periodic lateralized epileptiform discharges (PLEDs): a form of partial status epilepticus? Seizure. 2001;10(4):260–5.

    CAS  PubMed  Google Scholar 

  56. Garzon E, Femandes RM, Sakamoto AC. Serial EEG during human status epilepticus: evidence for PLEDs as an ictal pattern. Neurology. 2001;57(7):1175–83.

    CAS  PubMed  Google Scholar 

  57. Reiher J, Rivest J, Grand’Maison F, et al. Periodic lateralized epileptiform discharges with transitional rhythmic discharges: association with seizures. Electroencephalogr Clin Neurophysiol. 1991;78(1):12–7.

    CAS  PubMed  Google Scholar 

  58. De la Paz D, Brenner RR. Bilateral independent periodic lateralized epileptic discharges. Arch Neurol. 1981;38:713–5.

    PubMed  Google Scholar 

  59. Schwartz MS, Prior PF, Scott DF. The occurrence and evolution in the EEG of a lateralized periodic phenomenon. Brain. 1973;96(3):613–22.

    CAS  PubMed  Google Scholar 

  60. Cobb WA, Hill D. Electroencephalogram in subacute progressive encephalitis. Brain. 1950;73(3):392–404.

    CAS  PubMed  Google Scholar 

  61. Alajouanine T, Nehlil J. Clinical and electroencephalographic verification of a probable case of subacute sclerosing leukoencephalitis. Rev Neurol. 1955;93(2):435–7.

    CAS  PubMed  Google Scholar 

  62. Kaya D, Bingol CA. Significance of atypical triphasic waves for diagnosing nonconvulsive status epilepticus. Epilepsy Behav. 2007;11(4):567–77.

    PubMed  Google Scholar 

  63. Boulanger JM, Deacon C, Lecuyer D, et al. Triphasic waves versus nonconvulsive status epilepticus: EEG distinction. Can J Neurol Sci. 2006;33(2):175–80.

    PubMed  Google Scholar 

  64. Hirsch LJ, Claassen J, Mayer SA, et al. Stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs): a common EEG phenomenon in the critically ill. Epilepsia. 2004;45(2):109–23.

    PubMed  Google Scholar 

  65. Hirsch LJ, Pang T, Claassen J, et al. Focal motor seizures induced by alerting stimuli in critically ill patients. Epilepsia. 2008;49(6):968–73.

    PubMed  Google Scholar 

  66. Zaret BS. Prognostic and neurophysiological implications of concurrent burst suppression and alpha patterns in the EEG of post-anoxic coma. Electroencephalogr Clin Neurophysiol. 1985;61(4):199–209.

    CAS  PubMed  Google Scholar 

  67. Trinka EHJ. EEG in coma and brain death. Clin Neurophysiol. 2011;42(3):141–8.

    Google Scholar 

  68. DeLorenzo RJ, Waterhouse EJ, Towne AR, et al. Persistent non-convulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia. 1998;39(8):833–40.

    CAS  PubMed  Google Scholar 

  69. Krishnamurthy KB, Drislane FW. Depth of EEG suppression and outcome in barbiturate anesthetic treatment for refractory status epilepticus. Epilepsia. 1999;40(6):759–62.

    CAS  PubMed  Google Scholar 

  70. Brenner RP. How useful is EEG and EEG monitoring in the acutely ill and how to interpret it? Epilepsia. 2009;50(Suppl 12):34–7.

    PubMed  Google Scholar 

  71. Kaplan PW. Assessing the outcomes in patients with nonconvulsive status epilepticus: nonconvulsive status epilepticus is under-diagnosed, potentially overtreated, and confounded by comorbidity. J Clin Neurophysiol. 1999;16(4):341–52.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

A special thanks to the EEG technicians of San Raffaele Hospital of Milan, Alessandra Amato, Sara Bruno, Aldo Elia, Claudia Paleari, and Amelia Tirelli, for the competence in carrying out of the exams. We also mentioned Laura Schieppati e Lucrezia Nava for English translation of the text and Marco Vabanesi and Marco Cursi for the relevant contribution to the activity of our laboratory.

Author information

Authors and Affiliations

  1. Department of Neurology, Chief of Epilepsy Center, Ospedale San Raffaele, Milan, Italy

    Fabio Minicucci

  2. Department of Neurology, Ospedale San Raffaele, Milan, Italy

    Matteo Impellizzeri & Giovanna Fanelli

Authors
  1. Fabio Minicucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matteo Impellizzeri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giovanna Fanelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fabio Minicucci .

Editor information

Editors and Affiliations

  1. Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy

    Oriano Mecarelli

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Cite this chapter

Minicucci, F., Impellizzeri, M., Fanelli, G. (2019). Status Epilepticus in Adults. In: Mecarelli, O. (eds) Clinical Electroencephalography. Springer, Cham. https://doi.org/10.1007/978-3-030-04573-9_32

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-04573-9_32

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-04572-2

  • Online ISBN: 978-3-030-04573-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation