Non-convulsive status epilepticus — SCE Neurology MCQ

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HardEpilepsyNon-convulsive status epilepticusSCE Neurology

An older patient remains confused 18 hours after a focal-to-bilateral tonic-clonic seizure. Attention fluctuates and the left face twitches intermittently; CT shows only an old infarct and metabolic tests are normal. Which investigation is required urgently?

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Correct answer: B — Urgent EEG to assess for non-convulsive status epilepticus

The best answer is “Urgent EEG to assess for non-convulsive status epilepticus”. Prolonged fluctuating impaired awareness with subtle focal motor activity after a convulsion is a classic presentation of non-convulsive status, which requires EEG confirmation and rapid treatment. “Serum prolactin measured 18 hours after the convulsion” is less appropriate because prolactin is time-limited and cannot diagnose persistent electrographic seizures “Carotid Doppler imaging as the test for ongoing ictal activity” is less appropriate because vascular imaging does not demonstrate ongoing cerebral electrical activity “Elective repeat CT in six weeks without electrophysiology” is less appropriate because delayed structural imaging leaves potentially treatable status unrecognised “Lumbar puncture deferred until the facial twitching has resolved” is less appropriate because CSF may be relevant to a cause but does not replace immediate seizure detection

Reference: NICE NG217: Epilepsies in children, young people and adults. https://www.nice.org.uk/guidance/ng217/chapter/Recommendations ACNS standardized critical-care EEG terminology 2021. https://pubmed.ncbi.nlm.nih.gov/33475321/