NCSE seizure: recognising a medical emergency

NCSE means non-convulsive status epilepticus. A person may appear awake but be confused, unresponsive, staring, unusually sleepy or unable to speak normally. There may be small repeated movements of the eyelids, face or hands, or behaviour that seems out of character. Because obvious convulsions may be absent, the condition can be mistaken for faintness, a psychiatric problem or ordinary confusion.

Diagnosis usually requires urgent clinical assessment and brain-wave monitoring. Causes can include missed seizure medicine, alcohol withdrawal, low blood sugar, infection or a previous seizure disorder. Meningitis and Hypoglycaemia are examples of conditions that can need rapid treatment.

Call emergency services if someone has a first unexplained episode of altered awareness, does not return to their usual state, or has repeated episodes without recovery. Keep the person away from traffic, stairs and water. Stay with them, note when the change began, and describe movements, speech and responsiveness to responders.

Do not restrain them, put anything in their mouth, give food or drink, or try to force tablets into an unresponsive person. If they are breathing but not fully alert, place them on their side when safe and follow the emergency dispatcher’s instructions.

NCSE is an emergency: seek immediate help for persistent confusion, staring, unresponsiveness or repeated subtle seizure-like movements, even without shaking. Urgency is especially high with breathing difficulty, injury, fever, severe headache, stiff neck, new weakness or suspected low blood sugar.

Do not wait for the episode to become dramatic. A person with epilepsy should follow their individual seizure plan if one exists, while a bystander contacts emergency services when the plan does not quickly restore normal awareness.

Could these episodes be NCSE or another cause of altered awareness? Do I need an updated seizure plan, medicine review or monitoring? Which rescue treatment can a trained caregiver give, and when should emergency services be called?