{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T21:15:29Z","timestamp":1790198129477,"version":"4.1.0"},"reference-count":31,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T00:00:00Z","timestamp":1688947200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The Salzburg criteria for nonconvulsive status epilepticus (NCSE) and the American Clinical Neurophysiology Society (ACNS) Standardized Critical Care EEG Terminology 2021 include a diagnostic trial with intravenous (IV) antiseizure medications (ASMs) to assess electroencephalographic (EEG) and clinical response as a diagnostic criterion for definite NCSE and possible NCSE. However, how to perform this diagnostic test and assessing the EEG and clinical responses have not been operationally defined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a Delphi process involving six experts to standardize the diagnostic administration of IV ASM and propose operational criteria for EEG and clinical response.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Either benzodiazepines (BZDs) or non\u2010BZD ASMs can be used as first choice for a diagnostic IV ASM trial. However, non\u2010BZDs should be considered in patients who already have impaired alertness or are at risk of respiratory depression. Levetiracetam, valproate, lacosamide, brivaracetam, or (if the only feasible drug) fosphenytoin or phenobarbital were deemed appropriate for a diagnostic IV trial. The starting dose should be approximately two thirds to three quarters of the full loading dose recommended for treatment of status epilepticus, with an additional smaller dose if needed. ASMs should be administered during EEG recording under supervision. A monitoring time of at least 15\u2009min is recommended. If there is no response, a second trial with another non\u2010BDZ or BDZs may be considered. A positive EEG response is defined as the resolution of the ictal\u2013interictal continuum pattern for at least three times the longest previously observed spontaneous interval of resolution (if any), but minimum of one continuous minute. For a clinical response, physicians should use a standardized examination before and after IV ASM administration. We suggest a definite time\u2010locked improvement in a focal deficit or at least one\u2010step improvement on a new dedicated one\u2010domain 10\u2010level NCSE response scale.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>The proposed standardized approach of a diagnostic IV ASM trial further refines the ACNS and Salzburg diagnostic criteria for NCSE.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.17694","type":"journal-article","created":{"date-parts":[[2023,6,25]],"date-time":"2023-06-25T00:23:04Z","timestamp":1687652584000},"page":"2351-2360","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":58,"title":["Diagnosing nonconvulsive status epilepticus: Defining electroencephalographic and clinical response to diagnostic intravenous antiseizure medication trials"],"prefix":"10.1111","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8552-6762","authenticated-orcid":false,"given":"Markus","family":"Leitinger","sequence":"first","affiliation":[{"name":"Department of Neurology, member of European Reference Network EpiCARE, Center for Cognitive Neuroscience Christian Doppler University Hospital, Paracelsus Medical University  Salzburg Austria"},{"name":"Neuroscience Institute, Center for Cognitive Neuroscience Christian Doppler University Hospital, Paracelsus Medical University  Salzburg Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1148-6723","authenticated-orcid":false,"given":"Nicolas","family":"Gaspard","sequence":"additional","affiliation":[{"name":"H\u00f4pital Universitaire de Bruxelles\u2013H\u00f4pital Erasme  Brussels Belgium"},{"name":"Universit\u00e9 Libre de Bruxelles  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6333-832X","authenticated-orcid":false,"given":"Lawrence J.","family":"Hirsch","sequence":"additional","affiliation":[{"name":"Comprehensive Epilepsy Center, Department of Neurology Yale University School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6035-6581","authenticated-orcid":false,"given":"S\u00e1ndor","family":"Beniczky","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurophysiology Danish Epilepsy Center  Dianalund Denmark"},{"name":"Department of Clinical Neurophysiology Aarhus University Hospital and Department of Clinical Medicine, Aarhus University  Aarhus Denmark"},{"name":"Department of Clinical Medicine Aarhus University  Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter 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