Prognosis in nonconvulsive status epilepticus

Determining the prognosis in nonconvulsive status epilepticus (NCSE) is com plicated by several factors. under-recognition of NCSE with its spontaneous resolution (thus decreasing the "denominator" of total cases that will hav e a poor outcome); incorrect diagnosis of NCSE based on misinterpretation o f EEC "epileptiform" activity; mis-classification of certain EEC patterns a s NCSE (e.g. PLEDs; triphasic waves); and grouping of different populations that have markedly different co-morbidities (ambulatory patients with NCSE together with comatose patients with electrographic seizure activity on EE C). There are almost no prospective studies with premorbid neuropsychometri c studies, and retrospective studies typically include isolated cases, or c ase series that include conditions in which the cause of NCSE itself causes cognitive morbidity. To summarize available data, absence status (ambulatory generalized nonconv ulsive status epilepticus) would appear to carry no lasting morbidity. Comp lex partial status epilepticus in ambulatory patients rarely results in mea surable permanent neurologic deficit, although rarely, short or long-standi ng deficits may clearly occur. Because intensive treatment with intravenous anticonvulsants (e.g. benzodia zepines or phenytoin) can confer morbidity, the equation has not yet been m ade as to whether the morbidity of such intensive treatment for all cases o f NCSE exceeds the morbidity of the disease itself. Larger, prospective stu dies will be needed to truly determine the prognosis in the different types of NCSE, stratified according to associated degrees of impairment (minimal ly impaired, moderately obtunded, comatose).