American Board of Internal Medicine (ABIM) Certification Practice Exam

What is an indication of nonconvulsive status epilepticus in patients with encephalitis?

1. Nonepileptic stress response

2. Presence of seizure activity on EEG without clinical manifestations

3. Persistent headache without seizures

4. Routine insomnia patterns

The correct answer is: Presence of seizure activity on EEG without clinical manifestations

The indication of nonconvulsive status epilepticus in patients with encephalitis is characterized by the presence of seizure activity on an electroencephalogram (EEG) without accompanying clinical manifestations. This form of status epilepticus can occur in patients who may appear to be stable or aware, yet still exhibit significant underlying seizure activity that can be detected through EEG monitoring. In the context of encephalitis, where inflammatory processes affect the brain and can disrupt normal electrical activity, it is critical to identify nonconvulsive seizures because they may not manifest with overt clinical symptoms. The EEG findings can reveal continuous or repetitive seizure patterns, which are vital for diagnosis and guiding management. Prompt recognition and treatment of nonconvulsive status epilepticus can significantly impact patient outcomes, making the identification based on EEG findings crucial. The other options do not indicate nonconvulsive status epilepticus as clearly. While a nonepileptic stress response or persistent headache may occur in various scenarios involving encephalitis, they lack the specific EEG evidence that defines nonconvulsive status epilepticus. Similarly, routine insomnia patterns are not directly related to seizure activity, as they often reflect behavioral or psychological factors rather than neurophysiological ones. Thus, monitoring EEG for seizure activity provides