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EEG criteria for nonconvulsive status epilepticus

Nonconvulsive status epilepticus (NCSE) represents a prolonged state of seizure(s) (status epilepticus—SE) without marked motor manifestations. NCSE typically encompasses an ictal impairment of cognition, subtle facial or limb twitches, eyes-open mutism, head or eye deviation, automatisms, and behavioral change. Owing to the pleomorphic clinical features that are consistent with diagnoses other than NCSE, confirmation of NCSE requires an EEG showing seizure activity. Further, the determination of SE on EEG is subjective. In most publications on these entities, authors make the “leap” to a diagnosis of SE without providing objective numeric criteria of frequency, amplitude, morphology, and evolution of EEG characteristics. Hence, “I know it when I see it.” Illustrative figures are often absent, may be ambiguous, or show the most evident cases. With these caveats in mind, this paper will review literature on EEG patterns reported to represent NCSE, explore borderline para-ictal patterns, comment on EEG response to benzodiazepines (BZPs), and association with seizures; and offer the author’s opinions.