What is the prognosis of nonconvulsive status epilepticus (SE)?

Updated: Feb 13, 2018
  • Author: Julie L Roth, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Models of partial epilepsy have demonstrated profound and long-lasting neurologic changes after experimental SE. In human studies, occasional patients have reportedly had profound memory and behavioral changes after episodes of complex partial SE. In some reports, the duration of the status was linked with these lasting memory deficits. However, most cohorts of patients with nonconvulsive did not undergo prestatus and poststatus neuropsychologic testing to permit direct comparison.

Krumholz and colleagues described 7 cases of serious morbidity and 3 deaths in patients with complex partial SE. [47] The study has been criticized because many of the patients had severe neurologic or medical insults in addition to status, which may have been pivotal in the genesis of their residual neurologic deficits. Nonetheless, 3 patients had prolonged memory and/or other cognitive deficits, possibly provoked by their SE.

Data from available studies suggest that nonconvulsive SE alone usually does not cause irreversible neurologic injury, though rare instances may occur. However, nonconvulsive SE appears so often in the company of serious neurologic or medical injury that clinically significant morbidity and mortality are common.

Patients with focal motor SE (ie, epilepsy partialis continua) have a particularly poor prognosis if they are untreated in the setting of Rasmussen encephalitis.

In the author's series of patients with focal SE, patients with new neurologic insults (eg, acute stroke) or those whose SE occurred postoperatively had a mortality rate of 67%. Those with a history of epilepsy did well overall. In this group, SE was usually precipitated by a new toxic and/or metabolic or other medical aggravator and had little to no lasting neurologic aftereffects.

The author compared patients with recurrent seizures with those who had ongoing, continuous seizure activity. No difference in outcome was observed between the subgroups of focal SE.

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