Nonconvulsive (Dialeptic) Status Epilepticus in Children

Many issues regarding the definition, phenomenology, categorization and outcome of nonconvulsive (or dialeptic) status epilepticus are still unresolved. Management is often difficult, with highly variable response to treatment. This classically includes oral benzodiazepines or steroids. New insights into pathophysiological mechanisms involved in sustaining epileptic activity or deficits in seizure termination may lead to improved management programs. Relevant synaptic processes implicate functional alterations of GABA, GABA and NMDA receptor complexes. Early results with NMDA blockers (e.g. ketamine) in animal models and pediatric patients are encouraging. Metabolic approaches have included ketogenic diets. Dynamic approaches of electroencephalographic signals may open the way to neuromodulation through electrical resetting techniques applied at critical phases.