Non-convulsive Status Epilepticus in Children, Electro-Clinical Profile and Response to a Specific Treatment Protocol

Abstract

Objective: Non-convulsive status epilepticus (NCSE) is an under-diagnosed
neurological condition. We report the electroclinical profile and treatment outcome of
children diagnosed with NCSE.
Methods: Total 45 children were identified with NCSE at the EEG laboratory from
September 2004 to January 2009. Their presenting complaints, past clinical and
birth related information were meticulously recorded. On diagnosis the referring
physicians were requested to repeat the test after starting treatment. Later they were
treated with a specific protocol on admission at the Neurology Unit of Dhaka Shishu
Hospital. Two lines of treatment with daily routine EEGs were introduced. Electroclinical
outcome were recorded on discharge. The children are still on regular follow
up to record the long-time result of the protracted treatment.
Results: Motor regression and postural problem were the primary complaints in the
majority (37/45, 82%) followed by involuntary movement, muscle twitching, jerks or
frequent fall (31/45, 69%), speech regression (29, 64%) and change of usual behavior
(25/45, 56%). Prior major seizures (generalized tonic clonic, tonic or clonic) was
reported in 32/45, 71%, within 1 week to 1 year. Initial diagnosis was multiple including
hysteric conversion reaction, post-ictal regression or neuro-degenerative disorder.
None was suspected with NCSE. Diagnosis was confirmed by the EEG finding of
continuous generalized (82%) or localized (18%) slow spike-wave complexes. On
protracted treatment, 82% achieved the target.
Conclusion: NCSE is common in children, may occur de-novo. The variable phenotype
may lead to erroneous diagnosis. A protracted treatment protocol is suggested. Further
reporting on this issue will help to assist the clinicians for early-diagnosis and treatment.

Key words: non-convulsive status epilepticus; electro-clinical diagnosis; motor
functional regression; speech regression; behavioural changes.

DOI: 10.3329/bjch.v33i3.5689

Bangladesh Journal of Child Health 2009; Vol.33(3): 90-99