Frequency and Types of Complications Encountered in Patients With Nonconvulsive Status Epilepticus in the Neurological ICU: Impact on Outcome

2021 ◽  
pp. 155005942110467
Author(s):  
Nese Dericioglu ◽  
Cansu Ayvacioglu Cagan ◽  
Okan Sokmen ◽  
Ethem Murat Arsava ◽  
Mehmet Akif Topcuoglu
Keyword(s):  
Status Epilepticus ◽  
Nonconvulsive Status Epilepticus ◽  
Study Group ◽  
Eeg Monitoring ◽  
Health Records ◽  
Prolonged Stay ◽  
Endoscopic Gastrostomy ◽  
Physician Awareness ◽  
The Impact ◽  
Video Eeg

Objectives. The frequency and types of complications in patients with nonconvulsive status epilepticus (NCSE) who are followed up in the intensive care unit (ICU), and the impact of these complications on outcome are not well-known. We investigated the complications and their effects on prognosis in NCSE patients. Methods. After reviewing the video-EEG monitoring (VEEGM) reports of all the consecutive patients who were followed up in our ICU between 2009 and 2019, we identified two groups of patients: 1-patients with NCSE (study group) and 2-patients who underwent VEEGM for possible NCSE but did not have ictal recordings (no-NCSE group). Electronic health records were reviewed to identify demographic and clinical data, duration of ICU care, medical and surgical complications, pharmacologic treatment, and outcome. These parameters were compared statistically between the groups. We also investigated the parameters affecting prognosis at discharge. Results. Thirty-two patients with NCSE comprised the study group. Infection developed in 84%. More than half were intubated, had tracheostomy or percutaneous endoscopic gastrostomy application. Refractory NCSE was associated with significantly more frequent complications and worse outcome. There was a higher tendency of infections in the study group ( P = .059). Higher organ failure scores and prolonged stay in ICU predicted worse outcome ( P < .05). Conclusion. The frequency of complications in patients with NCSE who are cared for in the ICU is considerable. Most of the complications are similar to the other patients in ICU, except for the higher frequency of infections. Increased physician awareness about modifiable parameters and timely interventions might help improve prognosis.

Continuous video-EEG monitoring increases detection rate of nonconvulsive status epilepticus in the ICU

Epilepsia ◽  
2011 ◽  
Vol 52 (3) ◽  
pp. 453-457 ◽  
Author(s):  
Raoul Sutter ◽  
Peter Fuhr ◽  
Leticia Grize ◽  
Stephan Marsch ◽  
Stephan Rüegg
Keyword(s):  
Status Epilepticus ◽  
Detection Rate ◽  
Nonconvulsive Status Epilepticus ◽  
Eeg Monitoring ◽  
Video Eeg

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.

Occurrence of seizure clusters and status epilepticus during inpatient video-EEG monitoring

Neurology ◽  
2003 ◽  
Vol 60 (6) ◽  
pp. 975-978 ◽  
Author(s):  
A.B. Rose ◽  
P.H. McCabe ◽  
F.G. Gilliam ◽  
B.J. Smith ◽  
J.G. Boggs ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Eeg Monitoring ◽  
Video Eeg

Clinical Characteristics and Nonconvulsive Seizures in Young Children With Abusive Head Trauma

2019 ◽  
Vol 34 (12) ◽  
pp. 713-719
Author(s):  
Ahyuda Oh ◽  
Larry D. Olson ◽  
Joshua J. Chern ◽  
Hyunmi Kim
Keyword(s):  
Status Epilepticus ◽  
Head Trauma ◽  
Mental Status ◽  
Abusive Head Trauma ◽  
Altered Mental Status ◽  
Nonconvulsive Status Epilepticus ◽  
Fisher Exact Test ◽  
Short Term ◽  
Nonconvulsive Seizures ◽  
The Impact

Aim: We aimed to evaluate putative predictors of symptoms and signs at admission for nonconvulsive seizure and to examine the impact of nonconvulsive seizures on short-term outcomes. Method: We retrospectively collected consecutive abusive head trauma patients (<36 months of age) from the trauma registry at Children’s Healthcare of Atlanta between 2009 and 2014. Multiple logistic regression was performed to assess the putative predictors for the occurrence of nonconvulsive seizures including clinical seizures, altered mental status, respiratory difficulty, and cardiac arrest at admission, while controlling for age, sex, and injury severity. The Mann-Whitney U test and the Fisher exact test were used to compare the short-term outcomes between patients with and without nonconvulsive seizures. Results: Two hundred seventy patients with abusive head trauma were identified (male = 55.6%). The median age was 4 months (interquartile range = 2-8 months). Among 70 patients who underwent continuous electroencephalography (EEG), 40 had nonconvulsive seizures (57%) and 21 developed nonconvulsive status epilepticus (30%). Altered mental status at admission was associated with the occurrence of nonconvulsive seizures (odds ratio = 6.8, 95% confidence interval = 1.2-38.2, P = .03). Comparing patients with no seizures, those with nonconvulsive seizures were more likely to stay longer at hospital (9 days vs 14 days, P = .04) and to need rehabilitation (50.0% vs 63.2%, P = .03). Conclusions: Nonconvulsive seizures and nonconvulsive status epilepticus was highly prevalent in young pediatric patients with abusive head trauma. Presenting with altered mental status at admission was found to predict the occurrence of nonconvulsive seizures. Nonconvulsive seizures had an unfavorable impact on short-term outcomes.

Nonconvulsive Status Epilepticus

2017 ◽  
Author(s):  
Frank W Drislane ◽  
Susan T Herman ◽  
Peter W Kaplan
Keyword(s):  
Status Epilepticus ◽  
Clinical Presentation ◽  
Clinical Signs ◽  
Nonconvulsive Status Epilepticus ◽  
Eeg Monitoring ◽  
Continuous Eeg ◽  
Absence Status ◽  
Continuous Eeg Monitoring ◽  
Better Than ◽  
Partial Status

The clinical presentation and encephalographic (EEG) findings of nonconvulsive status epilepticus (NCSE) can be complicated, making diagnosis difficult. There are generalized (e.g., absence status) and focal (e.g., aphasic status, complex partial status) forms. Some patients are responsive but have cognitive or other neurologic deficits; others are less responsive or even comatose. Increasingly, the diagnosis of NCSE is considered in intensive care unit patients. Here, without clinical signs of seizures such as convulsions, EEG is critical in diagnosis, but there is uncertainty about which EEG patterns represent seizures and which clinical situations and EEG patterns warrant aggressive treatment. Antiseizure medications are tailored to the NCSE type and the clinical condition. Treatment is often easier for NCSE, and the outcome better, than for convulsive SE, but this is not always true for critically ill patients with NCSE in the ICU, for whom continuous EEG monitoring is often crucial for diagnosis and management.

Continuous EEG monitoring and midazolam infusion for refractory nonconvulsive status epilepticus

Neurology ◽  
2001 ◽  
Vol 57 (6) ◽  
pp. 1036-1042 ◽  
Author(s):  
J. Claassen ◽  
L. J. Hirsch ◽  
R. G. Emerson ◽  
J. E. Bates ◽  
T. B. Thompson ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Nonconvulsive Status Epilepticus ◽  
Eeg Monitoring ◽  
Midazolam Infusion ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring

Neurologist, 22 years’ experience, Germany

2020 ◽  
pp. 98-100
Author(s):  
Markus Reuber ◽  
Gregg H. Rawlings ◽  
Steven C. Schachter
Keyword(s):  
Status Epilepticus ◽  
Antibiotic Treatment ◽  
Successful Treatment ◽  
Psychological Support ◽  
Eeg Monitoring ◽  
Antiepileptic Treatment ◽  
Complete Failure ◽  
Clonic Seizures ◽  
Video Eeg ◽  
Suspected Diagnosis

This chapter highlights the experience of a neurologist who was consulted to assist with a patient’s antiepileptic treatment when he was transferred to a hospital with a suspected diagnosis of encephalitis. After he had been transferred, several bilateral tonic-clonic seizures were observed, which progressed to status epilepticus despite a combination of antiviral and antibiotic treatment. Over the following years, his epilepsy proved highly pharmacoresistant. Soon after the major impact of his disease on his previously highly successful life became apparent, he felt that he needed psychological support and started psychotherapy. When the neurologist decided to arrange another period of video-EEG monitoring, five different seizure types were recorded. Three were clearly epileptic. However, he also had five seizures with clear dissociative components. Ultimately, this patient exemplifies a major failure—both in terms of successful treatment of his multifocal epilepsy with severe vocational and private consequences and in terms of the complete failure to consider those seizure elements that turned out to be non-epileptic.

scholarly journals A case of nonconvulsive status epilepticus presenting as dissociative fugue

2013 ◽  
Vol 19 (4) ◽  
pp. 2
Author(s):  
Almila Erol ◽  
Ayla Yigit ◽  
Gozde Dogan ◽  
Behiye Ozer
Keyword(s):  
Status Epilepticus ◽  
Clonic Seizure ◽  
Nonconvulsive Status Epilepticus ◽  
Partial Status Epilepticus ◽  
Level Of Consciousness ◽  
Grand Mal ◽  
Clonic Seizures ◽  
Electroencephalogram Eeg ◽  
Video Eeg ◽  
Partial Status

<p><span>Nonconvulsive status epilepticus is characterised by changes in behaviour, memory, affect or level of consciousness. We report a case of nonconvulsive status epilepticus precipitated by carbamazepine that presented as dissociative fugue. The patient was a 49-year-old man. He first experienced a tonic-clonic seizure nine years previously and was diagnosed with <em>grand mal</em> epilepsy. He had been using carbamazepine 800 mg daily for the last eight years. He had not had any tonic-clonic seizures since carbamazepine was introduced but began to display behavioural disturbances periodically. He also left home many times, and remembered nothing about the period he had been away after he returned. He was hospitalised with a preliminary diagnosis of dissociative fugue. He had recurrent episodes with dissociative symptoms during his stay in the hospital. An electroencephalogram (EEG) and a 24-hour video EEG revealed nothing abnormal. An EEG recording taken during an episode indicated complex partial status epilepticus. Carbamazepine was substituted with valproate, and the patient was discharged in remission. </span></p>

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