Abstract
Status epilepticus (SE) occurs when a continuous epileptic seizure lasts for more than 30 min, or intermittent epileptic seizures recur without intervening recovery to baseline neurologic function (1). For practical clinical purposes, 10 min of continuous seizure activity is often used as a criterion for diagnosis of SE (2). While most cases of convulsive SE are easy to diagnose by clinical criteria alone, the electroencephalogram (EEG) is an essential tool for the diagnosis and classification of nonconvulsive SE (NCSE). EEG is also valuable in classifying SE and in monitoring the response to therapy. The clinical manifestations and treatment of SE are discussed thoroughly in other chapters; this chapter will focus on the electrographic patterns of SE and the utility of EEG for diagnosis, classification, and management of SE.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Treatment of convulsive status epilepticus. Recommendations of the Epilepsy Foundation of America’s Working Group on Status Epilepticus. JAMA 1993;270:854–859.
Treiman DM. Generalized convulsive status epilepticus. In: Engel J Jr, Pedley TA, eds. Epilepsy: A Comprehensive Textbook. Philadelphia: Lippincott-Raven; 1997:669–680.
Gastaut H. Classification of status epilepticus. Adv Neurol 1983;34:15–35.
Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Classification and Terminology of the International League Against Epilepsy. Epilepsia 1981;22:489–501.
Granner MA, Lee SI. Nonconvulsive status epilepticus: EEG analysis in a large series. Epilepsia 1994;35:42–47.
Treiman DM, Walton NY, Kendrick C. A progressive sequence of electroencephalographic changes during generalized convulsive status epilepticus. Epilepsy Res 1990;5:49–60.
Scheuer ML. Continuous EEG monitoring in the intensive care unit. Epilepsia 2002;43(Suppl 3):114–127.
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;47:83–89.
Jordan KG. Continuous EEG and evoked potential monitoring in the neuroscience intensive care unit. J Clin Neurophysiol 1993;10:445–475.
Fountain NB, Waldman WA. Effects of benzodiazepines on triphasic waves: implications for nonconvulsive status epilepticus. J Clin Neurophysiol 2001;18:345–352.
Roger J, Lob H, Tassinari C. Status epilepticus. In: Finken P, Bruyn G, eds. The Epilepsies. New York: American Elsevier; 1974:145–188.
Treiman DM. Electroclinical features of status epilepticus. J Clin Neurophysiol 1995;12:343–362.
Tassinari CA, Dravet C, Roger J, Cano JP, Gastaut H. Tonic status epilepticus precipitated by intravenous benzodiazepine in five patients with Lennox-Gastaut syndrome. Epilepsia 1972;13:421–435.
Jumao-as A, Brenner RP. Myoclonic status epilepticus: a clinical and electroencephalographic study. Neurology 1990;40:1199–1202.
Kimura S, Kobayashi T. Two patients with juvenile myoclonic epilepsy and nonconvulsive status epilepticus. Epilepsia 1996;37:275–279.
Celesia GG, Grigg MM, Ross E. Generalized status myoclonicus in acute anoxic and toxic-metabolic encephalopathies. Arch Neurol 1988;45:781–784.
Wijdicks EF, Young GB. Myoclonus status in comatose patients after cardiac arrest. Lancet 1994;343(8913):1642–1643.
Krumholz A, Stern BJ, Weiss HD. Outcome from coma after cardiopulmonary resuscitation: relation to seizures and myoclonus. Neurology 1988;38:401–405.
Young GB, Gilbert JJ, Zochodne DW. The significance of myoclonic status epilepticus in postanoxic coma. Neurology 1990;40:1843–1848.
Brown P, Thompson PD, Rothwell JC, Day BL, Marsden CD. A case of postanoxic encephalopathy with cortical action and brainstem reticular reflex myoclonus. Mov Disord 1991;6:139–144.
DeLorenzo RJ, Waterhouse EJ, Towne AR, Boggs JG, Ko D, DeLorenzo GA, Brown A, Garnett L. Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia 1998;39:833–840.
Nei M, Lee JM, Shanker VL, Sperling MR. The EEG and prognosis in status epilepticus. Epilepsia 1999;40:157–163.
Lowenstein D, Aminoff M. Clinical and EEG features of status epilepticus in comatose patients. Neurology 1992;42:100–104.
Andermann F, Robb JP. Absence status: a reappraisal following review of thirty-eight patients. Epilepsia 1972;13:177–187.
Baykan B, Gokyigit A, Gurses C, Eraksoy M. Recurrent absence status epilepticus: clinical and EEG characteristics. Seizure 2002;11:310–319.
Berkovic SF, Bladin PF. Absence status in adults. Clin Exp Neurol 1983;19:198–207.
Drislane FW, Schomer DL. Clinical implications of generalized electrographic status epilepticus. Epilepsy Res 1994;19:111–121.
Husain AM, Mebust KA, Radtke RA. Generalized periodic epileptiform discharges: etiologies, relationship to status epilepticus, and prognosis. J Clin Neurophysiol 1999;16:51–58.
Barry E, Hauser W. Status epilepticus: the interaction of epilepsy and acute brain disease. Neurology 1993;43:1473–1478.
Devinsky O, Kelley K, Porter RJ, Theodore WH. Clinical and electroencephalographic features of simple partial seizures. Neurology 1988;38:1347–1352.
Schomer DL. Focal status epilepticus and epilepsia partialis continua in adults and children. Epilepsia 1993;34(suppl 1):S29–36.
Grand’Maison F, Reiher J, Leduc CP. Retrospective inventory of EEG abnormalities in partial status epilepticus. Electroencephalogr Clin Neurophysiol 1991;79:264–270.
Drislane FW, Blum AS, Schomer DL. Focal status epilepticus: clinical features and significance of different EEG patterns. Epilepsia 1999;40:1254–1260.
Cockerell OC, Rothwell J, Thompson PD, Marsden CD, Shorvon SD. Clinical and physiological features of epilepsia partialis continua. Cases ascertained in the UK. Brain 1996;119(Pt 2):393–407.
Thomas JE, Reagan TJ, Klass DW. Epilepsia partialis continua. A review of 32 cases. Arch Neurol 1977;34:266–275.
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;17:177–193.
Garzon E, Fernandes RM, Sakamoto AC. Serial EEG during human status epilepticus: evidence for PLED as an ictal pattern. Neurology 2001;57:1175–1183.
Salanova V, Morris HH, Van Ness P. Kotagal P, Wyllie E, Luders H. Frontal lobe seizures: electroclinical syndromes. Epilepsia 1995;36:16–24.
Williamson PD, Boon PA, Thadani VM, Darcey TM, Spencer DD, Spencer SS, Novelly RA, Mattson RH. Parietal lobe epilepsy: diagnostic considerations and results of surgery. Ann Neurol 1992;31:193–201.
Williamson PD, French JA, Thadani VM, Kim JH, Novelly RA, Spencer SS, Spencer DD, Mattson RH. Characteristics of medial temporal lobe epilepsy: II. Interictal and ictal scalp electroencephalography, neuropsychological testing, neuroimaging, surgical results, and pathology. Ann Neurol 1993;34:781–787.
Foldvary N, Lee N, Thwaites G, Mascha E, Hammel J, Kim H, Friedman AH, Radtke RA. Clinical and electrographic manifestations of lesional neocortical temporal lobe epilepsy, Neurology 1997;49:757–763.
Nowack WJ, Shaikh IA. Progression of electroclinical changes in complex partial status epilepticus: filling in the blanks. Clin Electroencephalogr 1999;30:5–8.
Drislane FW. Presentation, evaluation, and treatment of nonconvulsive status epilepticus. Epilepsy Behav 2000;1:301–314.
Williamson PD, Spencer DD, Spencer SS, Novelly RA, Mattson RH. Complex partial status epilepticus: a depth-electrode study. Ann Neurol 1985;18:647–654.
Markand ON, Wheeler GL, Pollack SL. Complex partial status epilepticus (psychomotor status). Neurology 1978;28:189–196.
Mayeux R, Lueders H. Complex partial status epilepticus: case report and proposal for diagnostic criteria. Neurology 1978;28:957–961.
Ballenger C, King D, Gallagher B. Partial complex status epilepticus. Neurology 1983;33:1545–1552.
Tomson T, Svanborg E, Wedlund JE. Nonconvulsive status epilepticus: high incidence of complex partial status. Epilepsia 1986;27:276–285.
Tomson T, Lindbom U, Nilsson BY. Nonconvulsive status epilepticus in adults: thirty-two consecutive patients from a general hospital population. Epilepsia 1992;33:829–835.
Clancy RR. The contribution of EEG to the understanding of neonatal seizures. Epilepsia 1996;37(suppl 1):S52–59.
Olmos-Garcia de Alba G, Udaeta Mora E, Malagon Valdez J, Villaneuva Garcia D, Valarezo Crespo F. Neonatal status epilepticus II: Electroencephalographic aspects. Clin Electroencephalogr 1984;15:197–201.
Knauss TA, Carlson CB. Neonatal paroxysmal monorhythmic alpha activity. Arch Neurol 1978;35:104–107.
Mizrahi EM, Kellaway P. Characterization and classification of neonatal seizures. Neurology 1987;37:1837–1844.
Scher MS. Controversies regarding neonatal seizure recognition. Epileptic Disord 2002;4:139–158.
Patry G, Lyagoubi S, Tassinari CA. Subclinical “electrical status epilepticus” induced by sleep in children. A clinical and electroencephalographic study of six cases. Arch Neurol 1971;24:242–252.
Tassinari CA, Rubboli G, Volpi L, Meletti S, d’Orsi G, Franca M, Sabetta AR, Riguzzi P, Gardella E, Zaniboni A, Michelucci R. Encephalopathy with electrical status epilepticus during slow sleep or ESES syndrome including the acquired aphasia. Clin Neurophysiol 2000;111(Suppl 2):S94–102.
De Negri M. Electrical status epilepticus during sleep (ESES). Different clinical syndromes: towards a unifying view? Brain Dev 1997;19:447–451.
Landau WM, Kleffner FR. Syndrome of acquired epileptic aphasia with convulsive disorder in children. Neurology 1957;7:523–530.
Jayakar PB, Seshia SS Electrical status epilepticus during slow-wave sleep: a review. J Clin Neurophysiol 1991;8:299–311.
Walker MC, Howard RS, Smith SJ, Miller DH, Shorvon SD, Hirsch NP. Diagnosis and treatment of status epilepticus on a neurological intensive care unit. Q J Med 1996;89:913–920.
Wilner AN, Bream PR. Status epilepticus and pseudostatus epilepticus. Seizure 1993;2:257–260.
Howell SJ, Owen L, Chadwick DW. Pseudostatus epilepticus. Q J Med 1989;71:507–519.
Hirsch LJ, Claassen J. The current state of treatment of status epilepticus. Curr Neurol Neurosci Rep 2002;2:345–356.
Brenner RP, Schaul N. Periodic EEG patterns: classification, clinical correlation, and pathophysiology. J Clin Neurophysiol 1990;7:249–267.
Westmoreland BF, Klass DW, Sharbrough FW. Chronic periodic lateralized epileptiform discharges. Arch Neurol 1986;43:494–496.
Snodgrass SM, Tsuburaya K, Ajmone-Marsan C. Clinical significance of periodic lateralized epileptiform discharges: relationship with status epilepticus. J Clin Neurophysiol 1989;6:159–172.
Baykan B, Kinay D, Gokyigit A, Gurses C. Periodic lateralized epileptiform discharges: association with seizures. Seizure 2000;9:402–406.
Reiher J, Rivest J, Grand’Maison F, Leduc CP. Periodic lateralized epileptiform discharges with transitional rhythmic discharges: association with seizures. Electroencephalogr Clin Neurophysiol 1991;78:12–17.
Ali II, Pirzada NA, Vaughn BV. Periodic lateralized epileptiform discharges after complex partial status epilepticus associated with increased focal cerebral blood flow. J Clin Neurophysiol 2001;18:565–569.
Assal F, Papazyan JP, Slosman DO, Jallon P, Goerres GW. SPECT in periodic lateralized epileptiform discharges (PLEDs): a form of partial status epilepticus? Seizure 2001;10:260–265.
Handforth A, Cheng JT, Mandelkern MA, Treiman DM. Markedly increased mesiotemporal lobe metabolism in a case with PLEDs: further evidence that PLEDs are a manifestation of partial status epilepticus. Epilepsia 1994;35:876–881.
de la Paz D, Brenner RP. Bilateral independent periodic lateralized epileptiform discharges. Clinical significance. Arch Neurol 1981;38:713–715.
Treiman DM. Status epilepticus. Baillieres Clin Neurol 1996;5:821–839.
Lothman EW, Bertram EH, Bekenstein JW, Perlin JB. Self-sustaining limbic status epilepticus induced by ‘continuous’ hippocampal stimulation: electrographic and behavioral characteristic. Epilepsy Res 1989;3:107–119.
Krumholz A. Epidemiology and evidence for morbidity of nonconvulsive status epilepticus. J Clin Neurophysiol 1999;16:314–322; discussion 353.
Sheridan PH, Sato S. Triphasic waves of metabolic encephalopathy versus spike-wave stupor. J Neurol Neurosurg Psychiatry 1986;49:108–109.
Lancman ME, Marks S, Mahmood K, Lansen T. Atypical triphasic waves associated with the use of pentobarbital. Electroencephalogr Clin Neurophysiol 1997;102:175–177.
Claassen J, Hirsch LJ, Mayer SA. Treatment of status epilepticus: a survey of neurologists. J Neurol Sci 2003;211:37–41.
Beydoun A, Yen CE, Drury I. Variance of interburst intervals in burst suppression. Electroencephalogr Clin Neurophysiol 1991;79:435–439.
Quigg M, Shneker B, Domer P. Current practice in administration and clinical criteria of emergent EEG. J Clin Neurophysiol 2001;18:162–165.
Guberman A, Cantu-Reyna G, Stuss D, Broughton R. Nonconvulsive generalized status epilepticus: clinical features, neuropsychological testing, and long-term follow-up. Neurology 1986;36:1284–1291.
Lee SI. Nonconvulsive status epilepticus. Ictal confusion in later life. Arch Neurol 1985;42:778–781.
Vespa PM, Nuwer MR, Nenov V, Ronne-Engstrom E, Hovda DA, Bergsneider M, Kelly DF, Martin NA, Becker DP. Increased incidence and impact of nonconvulsive and convulsive seizures after traumatic brain injury as detected by continuous electroencephalographic monitoring. J Neurosurg 1999;91:750–760.
Vespa PM, O’Phelan K, Shah M, Mirabelli J, Starkman S, Kidwell C, Saver J, Nuwer MR, Frazee JG, McArthur DA, Martin NA. Acute seizures after intracerebral hemorrhage: A factor in progressive midline shift and outcome. Neurology 2003;60:1441–1446.
Towne AR, Waterhouse EJ, Boggs JG, Garnett LK, Brown AJ, Smith JR, Jr. DeLorenzo RJ, Smith JR Jr. Prevalence of nonconvulsive status epilepticus in comatose patients. Neurology 2000;54:340–345.
Privitera M, Hoffman M, Moore JL, Jester D. EEG detection of nontonic-clonic status epilepticus in patients with altered consciousness. Epilepsy Res 1994;18:155–166.
Litt B, Wityk RJ, Hertz SH, Mullen PD, Weiss H, Ryan DD, Henry TR. Nonconvulsive status epilepticus in the critically ill elderly. Epilepsia 1998;39:1194–1202.
Nevander G, Ingvar M, Auer R, Siesjo BK. Status epilepticus in well-oxygenated rats causes neuronal necrosis. Ann Neurol 1985;18:281–290.
Walker MC, Smith SJ, Shorvon SD. The intensive care treatment of convulsive status epilepticus in the UK. Results of a national survey and recommendations. Anaesthesia 1995;50:130–135.
Treiman DM, Meyers PD, Walton NY, Collins JF, Colling C, Rowan AJ, Handforth A, Faught E, Calabrese VP, Uthman BM, Ramsay RE, Mamdani MB. A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med 1998;339:792–798.
Claassen J, Hirsch LJ, Emerson RG, Bates JE, Thompson TB, Mayer SA. Continuous EEG monitoring and midazolam infusion for refractory nonconvulsive status epilepticus. Neurology 2001;57:1036–1042.
Claassen J, Hirsch LJ, Emerson RG, Mayer SA. Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: a systematic review. Epilepsia 2002;43:146–153.
Parent J, Lowenstein D. Treatment of refractory generalized status epilepticus with continuous infusion of midazolam. Neurology 1994;44:1837–1840.
Prasad A, Worrall BB, Bertram EH, Bleck TP. Propofol and midazolam in the treatment of refractory status epilepticus. Epilepsia 2001;42:380–386.
Van Ness PC. Pentobarbital and EEG burst suppression in treatment of status epilepticus refractory to benzodiazepines and phenytoin. Epilepsia 1990;31:61–67.
Rashkin MC, Youngs C, Penovich P. Pentobarbital treatment of refractory status epilepticus. Neurology 1987;37:500–503.
Lowenstein DH, Aminoff MJ, Simon RP. Barbiturate anesthesia in the treatment of status epilepticus: clinical experience with 14 patients. Neurology 1988;38:395–400.
Krishnamurthy KB, Drislane FW. Depth of EEG suppression and outcome in barbiturate anesthetic treatment for refractory status epilepticus. Epilepsia 1999;40:759–762.
Gotman J. Automatic seizure detection: improvements and evaluation. Electroencephalogr Clin Neurophysiol 1990;76:317–324.
Gotman J. Automatic detection of seizures and spikes. J Clin Neurophysiol 1999;16:130–140.
Webber WR, Lesser RP, Richardson RT, Wilson K. An approach to seizure detection using an artificial neural network (ANN). Electroencephalogr Clin Neurophysiol 1996;98:250–272.
Qu H, Gotman J. Improvement in seizure detection performance by automatic adaptation to the EEG of each patient. Electroencephalogr Clin Neurophysiol 1993;86:79–87.
Agarwal R, Gotman J. Long-term EEG compression for intensive-care settings. IEEE Eng Med Biol Mag 2001;20:23–29.
Jordan KG. Continuous EEG monitoring in the neuroscience intensive care unit and emergency department. J Clin Neurophysiol 1999;16:14–39.
Fountain NB, Lothman EW. Pathophysiology of status epilepticus. J Clin Neurophysiol 1995;12:326–342.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2005 Humana Press Inc., Totowa, NJ
About this chapter
Cite this chapter
Herman, S.T. (2005). The Electroencephalogram in Status Epilepticus. In: Drislane, F.W. (eds) Status Epilepticus. Current Clinical Neurology. Humana Press. https://doi.org/10.1385/1-59259-945-1:077
Download citation
DOI: https://doi.org/10.1385/1-59259-945-1:077
Publisher Name: Humana Press
Print ISBN: 978-1-58829-355-8
Online ISBN: 978-1-59259-945-5
eBook Packages: MedicineMedicine (R0)