Prevalence of nonconvulsive status epilepticus in comatose patients
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To the Editor:
We read with interest the article by Towne et al.1 and applaud their efforts in this extremely important and challenging issue in clinical neurology. The key finding was that 8% of comatose patients with no overt seizure activity were found by EEG to be in nonconvulsive status epilepticus (NCSE). This impressively high percentage largely depends on the definition of EEG status epilepticus, and we raise questions about the criteria used.
The authors define NCSE as “continuous or nearly continuous electrographic seizure activity lasting at least 30 minutes.” However, there is no agreement on exactly what constitutes electrographic seizure activity. Some EEG patterns are relatively specific for NCSE—for example, repetitive and discrete partial electrographic seizures such as the one shown in the authors’ figure 4, or the continuous 3-Hz spike-wave complexes pattern seen in absence status. The example shown in the authors’ figure 3 is much less convincing. This pattern, which could be variably described as rhythmic sharp waves, slow spike-wave complexes, periodic pattern, triphasic waves, or generalized periodic epileptiform discharges (GPED), is not as specific for status epilepticus as implied by the authors. In fact, it is extremely common in nonepileptic encephalopathies, especially anoxic …
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