Are We Prepared to Detect Subtle and Nonconvulsive Status Epilepticus in Critically Ill Patients?

2016 ◽  
Vol 33 (1) ◽  
pp. 25-31 ◽  
Author(s):  
Raoul Sutter
Keyword(s):  
Status Epilepticus ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Nonconvulsive Status Epilepticus

Reevaluation of the Critically Ill Patients With Nonconvulsive Status Epilepticus by Using Salzburg Consensus Criteria

2018 ◽  
Vol 49 (6) ◽  
pp. 425-432 ◽  
Author(s):  
Ozlem Gungor Tuncer ◽  
Ebru Altindag ◽  
Sevda Ozel Yildiz ◽  
Mecbure Nalbantoglu ◽  
Mehmet Eren Acik ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Laboratory ◽  
Laboratory Data ◽  
Real Life ◽  
Nonconvulsive Status Epilepticus ◽  
Life Evaluation ◽  
Ictal Eeg ◽  
Eeg Data

Objective. We aimed to assess the usefulness of the Salzburg Consensus Criteria (SCC) for determining the prognosis of critically ill patients with nonconvulsive status epilepticus (NCSE). Methods. We retrospectively reviewed consecutive patients with unconsciousness followed up in the intensive care unit (ICU). Three clinical neurophysiologists, one of them blinded to clinical and laboratory data, reevaluated all EEG data independently and determined NCSE according to SCC. The incidence of NCSE and ictal EEG patterns and their relationship to clinical, laboratory, neuroradiological, and prognostic findings were assessed. Results. A total of 107 consecutive patients with mean age 68.2 ± 15.3 years (57 females) were enrolled in the study. Primary neuronal injury was detected in 59 patients (55.7%). Thirty-three patients (30.8%) were diagnosed as NCSE. While authors decided to treat 33 patients (30.8%), 32 patients (29.9%) had been treated in real-life evaluation. Clinical and EEG improvement were detected in 12 patients (11.3%) in real-life treatment group showing correlation with lack of intubation and ICU stay related to postsurgical event. Rate of mortality (45.8%) was high showing association with systemic-metabolic etiology, severity of coma and presence of “plus” modifiers in the EEG. Conclusion and Significance. Our findings suggest that SCC is highly compatible with clinical practice in the decision for treatment of patients with NCSE. The presence of “plus” modifiers in the EEG was found to be associated with mortality in these patients and was a significant marker for the high mortality rate.

Pharmacological Management of Seizures and Status Epilepticus in Critically Ill Patients

2010 ◽  
Vol 23 (5) ◽  
pp. 441-454 ◽  
Author(s):  
Eljim P. Tesoro ◽  
Gretchen M. Brophy
Keyword(s):  
Status Epilepticus ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Neurological Disease ◽  
Medical Emergency ◽  
Significant Morbidity ◽  
First Line ◽  
Short Term ◽  
Pharmacological Management ◽  
First Line Treatment

Seizures are serious complications seen in critically ill patients and can lead to significant morbidity and mortality if the cause is not identified and treated quickly. Uncontrolled seizures can lead to status epilepticus (SE), which is considered a medical emergency. The first-line treatment of seizures is an intravenous (IV) benzodiazepine followed by anticonvulsant therapy. Refractory SE can evolve into a nonconvulsive state requiring IV anesthetics or induction of pharmacological coma. To prevent seizures and further complications in critically ill patients with acute neurological disease or injury, short-term seizure prophylaxis should be considered in certain patients.

Outcomes in 140 critically ill patients with status epilepticus

2007 ◽  
Vol 34 (3) ◽  
pp. 476-480 ◽  
Author(s):  
Stéphane Legriel ◽  
Bruno Mourvillier ◽  
Nicolas Bele ◽  
Jose Amaro ◽  
Pierre Fouet ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Critically Ill ◽  
Critically Ill Patients

Association of systemic secondary brain insults and outcome in patients with convulsive status epilepticus

Neurology ◽  
2020 ◽  
Vol 95 (18) ◽  
pp. e2529-e2541
Author(s):  
Candice Fontaine ◽  
Virginie Lemiale ◽  
Matthieu Resche-Rigon ◽  
Maleka Schenck ◽  
Jonathan Chelly ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Therapeutic Hypothermia ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Standard Care ◽  
Controlled Trial ◽  
Convulsive Status Epilepticus ◽  
Open Label ◽  
Arterial Blood ◽  
Brain Insults

ObjectiveTo evaluate the association between systemic factors (mean arterial blood pressure, arterial partial pressures of carbon dioxide and oxygen, body temperature, natremia, and glycemia) on day 1 and neurologic outcomes 90 days after convulsive status epilepticus.MethodsThis was a post hoc analysis of the Evaluation of Therapeutic Hypothermia in Convulsive Status Epilepticus in Adults in Intensive Care (HYBERNATUS) multicenter open-label controlled trial, which randomized 270 critically ill patients with convulsive status epilepticus requiring mechanical ventilation to therapeutic hypothermia (32°C–34°C for 24 hours) plus standard care or standard care alone between March 2011 and January 2015. The primary endpoint was a Glasgow Outcome Scale score of 5, defining a favorable outcome, 90 days after convulsive status epilepticus.ResultsThe 172 men and 93 women had a median age of 57 years (45–68 years). Among them, 130 (49%) had a history of epilepsy, and 59 (29%) had a primary brain insult. Convulsive status epilepticus was refractory in 86 (32%) patients, and total seizure duration was 67 minutes (35–120 minutes). The 90-day outcome was unfavorable in 126 (48%) patients. In multivariate analysis, none of the systemic secondary brain insults were associated with outcome; achieving an unfavorable outcome was associated with age >65 years (odds ratio [OR] 2.17, 95% confidence interval [CI] 1.20–3.85; p = 0.01), refractory convulsive status epilepticus (OR 2.00, 95% CI 1.04–3.85; p = 0.04), primary brain insult (OR 2.00, 95% CI 1.02–4.00; p = 0.047), and no bystander-witnessed seizure onset (OR 2.49, 95% CI 1.05–5.59; p = 0.04).ConclusionsIn our population, systemic secondary brain insults were not associated with outcome in critically ill patients with convulsive status epilepticus.ClinicalTrials.gov identifierNCT01359332.

Nonconvulsive status epilepticus induced by acute hypothyroidism in a critically ill patient

2010 ◽  
Vol 37 (3) ◽  
pp. 553-554 ◽  
Author(s):  
Monica Rocco ◽  
Stefano Pro ◽  
Elisa Alessandri ◽  
Edoardo Vicenzini ◽  
Oriano Mecarelli
Keyword(s):  
Status Epilepticus ◽  
Critically Ill ◽  
Nonconvulsive Status Epilepticus ◽  
Critically Ill Patient ◽  
Acute Hypothyroidism

scholarly journals Nonconvulsive Status Epilepticus in the Critically Ill Elderly

Epilepsia ◽  
1998 ◽  
Vol 39 (11) ◽  
pp. 1194-1202 ◽  
Author(s):  
Brian Litt ◽  
Robert J. Wityk ◽  
Sharon H. Hertz ◽  
Paul D. Mullen ◽  
Howard Weiss ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Critically Ill ◽  
Nonconvulsive Status Epilepticus

scholarly journals Continuous EEG is associated with favorable hospitalization outcomes for critically ill patients

Neurology ◽  
2018 ◽  
Vol 92 (1) ◽  
pp. e9-e18 ◽  
Author(s):  
Chloe E. Hill ◽  
Leah J. Blank ◽  
Dylan Thibault ◽  
Kathryn A. Davis ◽  
Nabila Dahodwala ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Fold Increase ◽  
Administrative Claims ◽  
Altered Consciousness ◽  
Cross Sectional ◽  
Continuous Eeg

ObjectiveTo characterize continuous EEG (cEEG) use patterns in the critically ill and to determine the association with hospitalization outcomes for specific diagnoses.MethodsWe performed a retrospective cross-sectional study with National Inpatient Sample data from 2004 to 2013. We sampled hospitalized adult patients who received intensive care and then compared patients who underwent cEEG to those who did not. We considered diagnostic subgroups of seizure/status epilepticus, subarachnoid or intracerebral hemorrhage, and altered consciousness. Outcomes were in-hospital mortality, hospitalization cost, and length of stay.ResultsIn total, 7,102,399 critically ill patients were identified, of whom 22,728 received cEEG. From 2004 to 2013, the proportion of patients who received cEEG increased from 0.06% (95% confidence interval [CI] 0.03%–0.09%) to 0.80% (95% CI 0.62%–0.98%). While the cEEG cohort appeared more ill, cEEG use was associated with reduced in-hospital mortality after adjustment for patient and hospital characteristics (odds ratio [OR] 0.83, 95% CI 0.75–0.93, p < 0.001). This finding held for the diagnoses of subarachnoid or intracerebral hemorrhage and for altered consciousness but not for the seizure/status epilepticus subgroup. Cost and length of hospitalization were increased for the cEEG cohort (OR 1.17 and OR 1.11, respectively, p < 0.001).ConclusionsThere was a >10-fold increase in cEEG use from 2004 to 2013. However, this procedure may still be underused; cEEG was associated with lower in-hospital mortality but used for only 0.3% of the critically ill population. While administrative claims analysis supports the utility of cEEG for critically ill patients, our findings suggest variable benefit by diagnosis, and investigation with greater clinical detail is warranted.

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