Which conditions are included in the differential diagnoses of complex partial status epilepticus (CPSE)?

Updated: Feb 13, 2018
  • Author: Julie L Roth, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Complex partial status epilepticus

CPSE is associated with more differential diagnoses than SPSE because of its variable clinical manifestations and associated altered consciousness. In addition to TIA, stroke, and migraine, other key disturbances of CNS function that mimic CPSE include toxic or metabolic encephalopathy, delirium of diverse etiologies, and transient global amnesia.

Absence SE (persistent generalized 3-Hz spike-and-wave activity) may be clinically indistinguishable from CPSE. Prolonged postictal states may closely resemble, and are more common than, CPSE.

Psychiatric causes of decreased responsiveness resembling CPSE are familiar to many tertiary epilepsy referral centers. These include severe mood disorders, psychotic disorders, and related nonepileptic phenomena (ie, pseudo-CPSE).

Periodic lateralized epileptiform discharges (PLEDs) may occur with and without focal SE. In focal SE, PLEDs may represent an ictal correlate. This interpretation is supported by an overt clinical correlate (ie, focal twitching) or by improvement in the patient's findings on neurologic examination after PLED resolution, as may occur after treatment.

However, such clinical improvement may lag the disappearance of PLEDs by hours owing to residual postictal CNS dysfunction. Marked evolution of PLEDs, such as abrupt frequency or amplitude changes, may also signify an ictal correlate. Whether the absolute discharge frequency reliably differentiates interictal from ictal PLEDs remains controversial.

Single-photon emission computed tomography (SPECT) may assist in distinguishing ictal and interictal PLEDs in the setting of possible focal SE. [57] In instances of PLEDs in focal SE, SPECT may show focal hyperperfusion. [58]

Apart from focal SE, PLEDs often represent an interictal finding associated with acute structural CNS lesions (eg, infarct, tumor, infection) or a chronic CNS lesion with a new, superimposed systemic disturbance. In this setting, PLEDs are still associated with seizures in 70-80% of cases. Both focal SE and PLEDs arise from similar clinical contexts, and both imply an increased risk of future seizures and epilepsy.

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