EEG monitoring is at the core of status epilepticus

2013 ◽  
Vol 47 (1) ◽  
pp. 18
Author(s):  
PATRICE WENDLING
Keyword(s):  
Status Epilepticus ◽  
Eeg Monitoring ◽  
The Core

Time to Detection of the First Seizure in Patients With Nonconvulsive Status Epilepticus in the Neurological Intensive Care Unit

2019 ◽  
Vol 51 (1) ◽  
pp. 70-73
Author(s):  
Nese Dericioglu ◽  
Ethem Murat Arsava ◽  
Mehmet Akif Topcuoglu
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Status Epilepticus ◽  
Eeg Monitoring ◽  
Neurological Intensive Care Unit ◽  
Neurological Intensive Care ◽  
Eeg Recordings ◽  
Gcs Score ◽  
Early Seizure ◽  
Video Eeg

Video-EEG monitoring is often used to detect nonconvulsive status epilepticus (NCSE) in critical care patients. Short recording durations may fail to detect seizures. In this study, we investigated the time required to record the first ictal event, and whether it could be correlated with some clinical or EEG parameters. Video-EEG recordings of patients who were followed up in our neurological intensive care unit were evaluated retrospectively. The EEG recordings of patients with NCSE were reviewed to determine the timing of the first seizure occurrence. Demographic data and EEG findings were obtained from patient charts and EEG reports. Possible correlations between the presence of periodic discharges (PD), Glasgow Coma Scale (GCS) score and early seizure detection (defined as a seizure within the first hour of recording) were explored statistically. Out of 200 patients who underwent video-EEG monitoring, we identified 30 cases (15%; 18 male, 12 female; age 24-86 years; mean recording duration 99 hours) with NCSE. The first seizure was recorded within 0 to 1 hour in 22 patients (73%) and within 1 to 12 hours in 6 patients (22%). Interictal PDs were identified in 19 patients (63%). GCS score was ≤8 in 16 patients (53%). There was no correlation between early seizure detection and PDs (p=1.0) or GCS score ( P = .22). In our study, >90% of the seizures were captured within 12 hours. This finding suggests that most of the NCSE cases can be identified even in centers with limited resources. The presence or absence of PDs or GCS score does not predict the timing of the first seizure.

scholarly journals Concepts in Periodic Discharges: A Descriptive Study

2018 ◽  
Vol 05 (02) ◽  
pp. 068-074
Author(s):  
Laxmi Khanna ◽  
Nandini Agarwal ◽  
Sabita Kandel
Keyword(s):  
Traumatic Brain Injury ◽  
Status Epilepticus ◽  
Brain Injury ◽  
Multiorgan Failure ◽  
Autoimmune Encephalitis ◽  
Abnormal Behavior ◽  
Neurological Deficits ◽  
Eeg Monitoring ◽  
Herpes Encephalitis ◽  
Periodic Discharges

Abstract Introduction Periodic discharges are now known as the ictal–interictal continuum and represent ongoing injury in acute or chronic neurological illnesses. Objective The aim of our study was to identify periodic discharges in patients who have undergone continuous bedside electroencephalography (EEG) monitoring and to classify the EEG according to the current American Clinical Neurophysiology Society terminology. Materials and Methods The continuous bedside EEG records of intensive care patients admitted from August 2017 to July 2018 were analyzed. The clinical spectrum, the treatment, and outcome of each of these patients were monitored. Results Fifty cases of periodic discharges (11 children, 39 adults) were identified over 1 year from 2017 to 2018. The clinical presentation included 32% seizures, 16% status epilepticus, 20% coma, 16% fever with altered sensorium, 8% abnormal behavior, 4% strokes, and 4% traumatic brain injury. The diagnosis was 20% autoimmune encephalitis, 8% herpes encephalitis, 20% multiorgan failure, 4% traumatic brain injury, 16% status epilepticus, 16% posthypoxic encephalopathy, 4% strokes, 4% intracerebral bleeds, 4% meningitis, and 4% severe dementia. Lateralized periodic discharges were identified in 20%, bilateral independent periodic discharges in 20%, and generalized periodic discharges in 60%. Fifty-six percent patients recovered with residual neurological deficits and 44% succumbed to their illness. Conclusions Continuous bedside EEG monitoring has revolutionized the approach to seizures in critically ill patients. Despite a vigilant approach and diligent diagnosis of these abnormal rhythms, the mortality rate was 20% in patients with lateralized periodic discharges and 60% with bilateral and generalized periodic discharges (p ≤ 0.05).

Status Epilepticus after Electroconvulsive Therapy

1989 ◽  
Vol 155 (1) ◽  
pp. 119-121 ◽  
Author(s):  
Allan I. F. Scott ◽  
William Riddle
Keyword(s):  
Status Epilepticus ◽  
Electroconvulsive Therapy ◽  
Rare Complication ◽  
Eeg Monitoring ◽  
Prolonged Seizure ◽  
Intravenous Diazepam ◽  
The Status ◽  
Motor Movements

Status epilepticus is a rare complication of ECT. We describe a patient who suffered a prolonged seizure which required termination with intravenous diazepam. The status epilepticus was not accompanied by motor movements, and the diagnosis was made only because of simultaneous EEG monitoring. The incidence of status epilepticus after ECT may be underestimated.

scholarly journals Increased incidence and impact of nonconvulsive and convulsive seizures after traumatic brain injury as detected by continuous electroencephalographic monitoring

1999 ◽  
Vol 91 (5) ◽  
pp. 750-760 ◽  
Author(s):  
Paul M. Vespa ◽  
Marc R. Nuwer ◽  
Valeriy Nenov ◽  
Elisabeth Ronne-Engstrom ◽  
David A. Hovda ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Status Epilepticus ◽  
Brain Injury ◽  
Scale Score ◽  
Eeg Monitoring ◽  
Content Type ◽  
Continuous Eeg ◽  
Nonconvulsive Seizures ◽  
Continuous Eeg Monitoring ◽  
Fine Print

Object. The early pathophysiological features of traumatic brain injury observed in the intensive care unit (ICU) have been described in terms of altered cerebral blood flow, altered brain metabolism, and neurochemical excitotoxicity. Seizures occur in animal models of brain injury and in human brain injury. Previous studies of posttraumatic seizures in humans have been based principally on clinical observations without a systematic approach to electroencephalographic (EEG) recording of seizures. The purpose of this study was to determine prospectively the incidence of convulsive and nonconvulsive seizures by using continuous EEG monitoring in patients in the ICU during the initial 14 days postinjury.Methods. Ninety-four patients with moderate-to-severe brain injuries underwent continuous EEG monitoring beginning at admission to the ICU (mean delay 9.6 ± 5.4 hours) and extending up to 14 days postinjury. Convulsive and nonconvulsive seizures occurred in 21 (22%) of the 94 patients, with six of them displaying status epilepticus. In more than half of the patients (52%) the seizures were nonconvulsive and were diagnosed on the basis of EEG studies alone. All six patients with status epilepticus died, compared with a mortality rate of 24% (18 of 73) in the nonseizure group (p < 0.001). The patients with status epilepticus had a shorter mean length of stay (9.14 ± 5.9 days compared with 14 ± 9 days [t-test, p < 0.03]). Seizures occurred despite initiation of prophylactic phenytoin on admission to the emergency room, with maintenance at mean levels of 16.6 ± 2.8 mg/dl. No differences in key prognostic factors (such as the Glasgow Coma Scale score, early hypoxemia, early hypotension, or 1-month Glasgow Outcome Scale score) were found between the patients with seizures and those without.Conclusions. Seizures occur in more than one in five patients during the 1st week after moderate-to-severe brain injury and may play a role in the pathobiological conditions associated with brain injury.

scholarly journals Non-Convulsive Status Epilepticus at Pediatric Intensive Care Unit: A Single Center Experience

2021 ◽  
pp. 1-6
Author(s):  
Omnia F El-Rashiedy ◽  
◽  
Hanan M Ibrahim ◽  
Rania H Shatla ◽  
◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Status Epilepticus ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Convulsive Status Epilepticus ◽  
Eeg Monitoring ◽  
Single Center Experience ◽  
Abnormal Movements ◽  
Observational Cohort

Objective: Our study aims to estimate the incidence of non-convulsive status epilepticus (NCSE) in comatose children and to evaluate response to acute treatment with anticonvulsants. Material and methods: This is a prospective observational cohort study conducted in Pediatric Intensive Care Unit (PICU) of Ain-Shams University. Eighty patients presented with Glasgow coma scale (GCS) <8 and/or the presence of abnormal movements or vital sign fluctuations were enrolled in the study. All were subjected to EEG monitoring for at least 1 hour within 24 hours of presentation. Patients diagnosed as NCSE received anticonvulsant treatment and were reevaluated clinically and by EEG after 1 week. Results: Twenty four patients were diagnosed as NCSE (30%). EEG was normalized in 50% of patients after treatment. Conclusion: NCSE is possible to be under-recognized in the PICU settings because of the pleomorphic clinical features. Clinical suspension of NCSE and EEG monitoring for critically ill comatose children will improve their outcome

Prognostic Value of EEG Monitoring After Status Epilepticus: A Prospective Adult Study

1997 ◽  
Vol 14 (4) ◽  
pp. 326-334 ◽  
Author(s):  
Rakesh Jaitly ◽  
Joseph A. Sgro ◽  
Alan R. Towne ◽  
Daijin Ko ◽  
Robert J. DeLorenzo
Keyword(s):  
Status Epilepticus ◽  
Prognostic Value ◽  
Eeg Monitoring ◽  
Adult Study

Rolle des EEG-Neuromonitorings beim Status epilepticus im Kindesalter

2021 ◽  
Vol 52 (03) ◽  
pp. 145-149
Author(s):  
Ulrich Brandl
Keyword(s):  
Status Epilepticus ◽  
Eeg Monitoring

ZusammenfasungDas EEG-Neuromonitoring kann bei den verschiedenen klinischen Formen des Status epilepticus im Kindes- und Jugendalter einen erheblichen Beitrag zur diagnostischen Einschätzung und somit der Steuerung der Therapie leisten. Bei einem konvulsiven Status epilepticus ist sein Einsatz kein Bestandteil der Erstversorgung. Sobald die Indikation für eine Narkose (refraktärer Status epilepticus) gestellt wird, bekommt das EEG-Monitoring eine erhebliche Bedeutung sowohl bei der Steuerung der Narkosetiefe als auch bei der Erkennung subklinischer Durchbruchsanfälle. Daneben kann man damit nicht indizierte Maßnahmen bei langdauernden psychogenen Anfällen vermeiden. Beim nonkonvulsiven Status ist das EEG hingegen bereits bei der Diagnosestellung eine wesentliche Maßnahme, ist aber auch hier eine wertvolle Maßnahme zur Therapiekontrolle. Eine Sonderstellung nimmt das EEG-Monitoring in der Intensivmedizin ein, besonders bei encephalopathischen Krankheitsbildern. Subklinische, elektrographische Status als Komplikation sind bei komatösen Patienten anders kaum zu diagnostizieren. Es zeigte sich in mehreren Studien, dass sie einen ungünstigen Einfluss auf das neurologische Behandlungsergebnis haben.

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