**1. Introduction**

Nonconvulsive status epilepticus (NCSE) is accompanied with an altered mental status (AMS) without convulsive motor activity [1]. Because of the paucity of clinical symptoms, EEG is mandatory for the diagnosis of NCSE. In the intensive care unit (ICU), where the patient is often obtunded/comatose, cEEG monitoring is required to reveal NCSE. cEEG monitoring is important because of the difficulty distinguishing when AMS and coma are ictal and differentiating them from non-ictal


**Table 1.**

*Examples of delayed or missed NCSE diagnosis; from Kaplan [48].*

symptoms associated with underlying pathology such as posthypoxic, metabolic or septic encephalopathies, and the effects of sedative drugs. Furthermore, the diagnosis of NCSE is frequently delayed, with patients in the ICU having often other serious medical conditions. To diagnose NCSE a high degree of suspicion is required [2], and consequently NCSE remains unrecognized. **Table 1** shows how frequently the diagnosis of NCSE could be missed in the emergency room.

In the United States, the estimated incidence of status epilepticus (SE) is 15–20/100,000 cases per year [3], and NCSE is representing 63% of all SE [4]. Both nonconvulsive seizures (NCS) and NCSE occur very frequently in the ICU and emergency department (ED): NCSs/NCSE is recorded in 8% to 48% in ICU patients [5–8], many of which are fatal [9–11].

Prevalence of NCSE is reported from different geographical areas of the world in patients with AMS [12–16]; However, to our knowledge, there is no study reporting the frequency of NCSE in the Middle East and North Africa (MENA) region; in this vast geographic area, the only NCSE incidence/prevalence is described from the MENA's neighboring countries like Pakistan, India, Turkey, and Israel [17–21]. There is a need for studies regarding the prevalence and morbidity of NCSE in MENA countries [22].

There is also a lack of consensus regarding the EEG monitoring duration when looking for NCSE in ICU patients with AMS; the authors dealing with this issue report a considerable variation in the duration of cEEG monitoring [23–26].

The aims of this chapter are multiple:

