Diagnosis, treatment, and outcome prediction of non-convulsive status epilepticus in unconscious patients in intensive care units

BACKGROUND: Non-convulsive status epilepticus (NCSE) is a common definitive or exclusion diagnosis in patients with disorders of consciousness (DOC) on neurological or interdisciplinary intensive care units (ICU). Special expertise is required to ensure reliable diagnosis, targeted therapy management, and individual prognostication, particularly as NCSE is identified based solely on clinical and electroencephalographic findings. MAIN BODY: This narrative state-of-the-art review compiles and critically discusses the existing literature on various aspects of NCSE. We focus on the reliable initial diagnosis and further monitoring of NCSE using the Salzburg criteria and the 2HELP2B score, therapy options beyond current guideline recommendations, and prognosis assessment using established scores and metrics, such as STESS, SACE, EMSE, and END-IT. With compact tables and clear illustrations, comprehensive insights are presented in a concise structure to provide clear guidance for daily practice. CONCLUSION: NCSE is a common and complex disease entity observed in the ICU that requires dedicated and specialised diagnostics, therapy, monitoring, and outcome assessment. Evidence-based recommendations are now available for each of these critical processes to guide caregivers and relatives. However, the availability of continuous (cEEG), quantitative (qEEG) electroencephalography in the ICU and expertise in its interpretation are limiting factors in many clinical settings. This problem is becoming increasingly pronounced due to the reduced or complete lack of reimbursement for c/qEEG in the context of intensive care medicine in many countries.