scholarly journals Cyclic seizures with automatisms occurring during non-convulsive status epilepticus with lateralized periodic discharges caused by hyponatremia

2021 ◽  
Vol 13 (1) ◽  
pp. 56-62
Author(s):  
Takao Hashimoto ◽  
Hiromasa Sato ◽  
Tomomi Nakajo ◽  
Kazuhiro Oguchi
Keyword(s):  
Status Epilepticus ◽  
Convulsive Status Epilepticus ◽  
Periodic Discharges

scholarly journals Hyperperfusion in the thalamus on arterial spin labeling indicates non-convulsive status epilepticus

2020 ◽  
Author(s):  
Satoru Ohtomo ◽  
Hiroshi Otsubo ◽  
Hiroaki Arai ◽  
Yoshiteru Shimoda ◽  
Yoichiro Homma ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Critically Ill Patients ◽  
Arterial Spin Labeling ◽  
Spin Labeling ◽  
Convulsive Status Epilepticus ◽  
Impaired Consciousness ◽  
Periodic Discharges ◽  
Epileptiform Discharges ◽  
Delta Activity ◽  
Rhythmic Delta Activity

Abstract Non-convulsive status epilepticus describes the syndrome of unexplained impaired consciousness in critically ill patients. Non-convulsive status epilepticus is very likely to lead to delayed diagnosis and poor outcomes because of the absence of convulsive symptoms. EEG is essential for the diagnosis of non-convulsive status epilepticus to establish the association between periodic discharges and rhythmic delta activity in addition to ictal epileptiform discharges according to the Salzburg criteria. Arterial spin labeling, a type of perfusion MRI, has been applied for rapid and non-invasive evaluation of the ictal state. Ictal cerebral cortical hyperperfusion is the most common finding to demonstrate focal onset seizures. Hyperperfusion of the thalamus on single photon emission computed tomography was found in patients with impaired awareness seizures. We hypothesized that thalamocortical hyperperfusion on arterial spin labeling identifies non-convulsive status epilepticus and such thalamic hyperperfusion specifically associates with periodic/rhythmic discharges producing impaired consciousness without convulsion. We identified 27 patients (17 females; age 58-91 years) who underwent both arterial spin labeling and EEG within 24 hours of suspected non-convulsive status epilepticus. We analyzed 28 episodes of suspected non-convulsive status epilepticus and compared hyperperfusion on arterial spin labeling with periodic/rhythmic discharges. We evaluated 21 episodes as a positive diagnosis of non-convulsive status epilepticus according to the Salzburg criteria. We identified periodic discharges in 15 (12 lateralized and three bilateral independent) episodes and rhythmic delta activity in 13 (10 lateralized, one bilateral independent, two generalized) episodes. Arterial spin labeling showed thalamic hyperperfusion in 16 (11 unilateral, 5 bilateral) episodes and cerebral cortical hyperperfusion in 24 (20 unilateral, 4 bilateral) episodes. Thalamic hyperperfusion was significantly associated with non-convulsive status epilepticus (P = 0.0007; sensitivity, 76.2%; specificity, 100%), periodic discharges (P < 0.0001; 93.3%; 84.6%), and rhythmic delta activity (P = 0.0006; 92.3%; 73.3%). Cerebral cortical hyperperfusion was significantly associated with non-convulsive status epilepticus (P = 0.0017; 100%; 57.1%) and periodic discharges (P = 0.0349; 100%; 30.8%), but not with rhythmic delta activity. Thalamocortical hyperperfusion could be a new biomarker of non-convulsive status epilepticus according to the Salzburg criteria in critically ill patients. Specific thalamic hyperexcitability might modulate the periodic discharges and rhythmic delta activity associated with non-convulsive status epilepticus. Impaired consciousness without convulsions could be caused by predominant thalamic hyperperfusion together with cortical hyperperfusion but without ictal epileptiform discharges.

scholarly journals Lateralized periodic discharges associated with status epilepticus in the first year after stroke

2016 ◽  
Vol 24 (1) ◽  
pp. 15-23
Author(s):  
Hava Ozlem Dede ◽  
Nerses Bebek ◽  
Ozlem Gelisin ◽  
Murat Mert Atmaca ◽  
Nilufer Yesilot Barlas ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Etiologic Factor ◽  
First Year ◽  
Convulsive Status Epilepticus ◽  
Periodic Discharges ◽  
Structural Brain Damage ◽  
Antiepileptic Drug Treatment ◽  
History Of ◽  
Eeg Recordings ◽  
Imaging Signs

Summary Backgrand. Lateralized periodic discharges (LPDs) are infrequent electroencephalograph (EEG) findings, and may present in ictal or interictal form. They are regarded as potential electrophysiologic signs of convulsive or nonconvulsive status epilepticus (NCSE). We report four patients who presented with NCSE and one who presented with convulsive status epilepticus in the postictal period, characterized by LPDs in EEG recordings in the first year after stroke. Material and methods. We prospectively evaluated patients who clinically presented with status epilepticus associated LPDs between March 2014 and March 2015. We investigated patients that presented with a new stroke occurrence. We excluded the other LPD etiologies. EEG studies of five patients (two men) who were admitted to our emergency unit with confusion, three of whom had visual symptoms; four were treated for NCSE as diagnosed with LPDs. The fifth patient had convulsive status epilepticus with LPD in the postictal period. Results and Discussion. None of the five patients, who were aged between 68 and 92 years, showed any etiologic factor other than a history of cerebrovascular disease (CVD). Magnetic resonance imaging studies of the patients revealed old infarcts and transitional diffusion restrictions. The clinical and EEG findings decreased substantially upon antiepileptic drug treatment. Herein, we illustrate the first patient who had confusion, visual hallucinations, and ictal and interictal LPD in her consecutive EEGs. Conclusions. CVDs may pave the way for LPDs in patients with a history of stroke because CVDs cause structural brain damage. Patients who present with a similar clinical profile and imaging signs of stroke should be checked for NCSE, particularly in the presence of LPDs in EEGs.

scholarly journals Emergency management of the paediatric patient with convulsive status epilepticus

2021 ◽  
Vol 26 (1) ◽  
pp. 50-57
Author(s):  
Kyle C McKenzie ◽  
Cecil D Hahn ◽  
Jeremy N Friedman
Keyword(s):  
Clinical Practice ◽  
Status Epilepticus ◽  
Emergency Management ◽  
Treatment Algorithm ◽  
Position Statement ◽  
Convulsive Status Epilepticus ◽  
Pharmacological Management ◽  
The Past ◽  
New Treatment ◽  
New Evidence

Abstract This guideline addresses the emergency management of convulsive status epilepticus (CSE) in children and infants older than 1 month of age. It replaces a previous position statement from 2011, and includes a new treatment algorithm and table of recommended medications based on new evidence and reflecting the evolution of clinical practice over the past several years. This statement emphasizes the importance of timely pharmacological management of CSE, and includes some guidance for diagnostic approach and supportive care.

Salzburg Criteria, A Useful Tool in Non-Convulsive Status Epilepticus Diagnosis: A Retrospective Study

2021 ◽  
pp. 155005942199171
Author(s):  
Adriana Gómez Domínguez ◽  
Raidili C. Mateo Montero ◽  
Alba Díaz Cid ◽  
Antonio J. P. Mazarro ◽  
Ignacio R. Bailly-Bailliere ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Status Epilepticus ◽  
Prospective Studies ◽  
Correct Diagnosis ◽  
Original Description ◽  
Neurological Deficits ◽  
Convulsive Status Epilepticus ◽  
Poor Outcome

Introduction. Non-convulsive status epilepticus (NCSE) has been traditionally a challenging electroencephalographic (EEG) diagnosis. For this reason, Salzburg consensus criteria (SCC) have been proposed to facilitate correct diagnosis. Methods. We retrospectively reanalyzed 41 cases referred to our department (from 2016 to 2018) under the suspicion of NCSE. In this study, we compared the original description (standard criteria) versus the updated description (SCC) of the same EEG. Results. Originally, 15 patients were diagnosed as NCSE (37%) and 26 patients as no NCSE (63%), using the standard criteria. Then, we analyzed EEGs according to the SCC, which led to the following results: 9 patients fulfilled the criteria for definite NCSE (22%), 20 patients were diagnosed as possible NCSE (49%) and 12 patients were diagnosed as no NCSE (29%). Subsequently, when we analyze the outcome of possible NCSE cases, we note that 50% of these patients presented mild-poor outcome (neurological deficits, deceased). Indeed, we observed worse outcomes in patients previously diagnosed as no NCSE and untreated, specifically post-anoxic cases. Conclusions. Salzburg criteria seem to be a useful tool to support NCSE diagnosis, introducing the category of possible NCSE. In our study, we observed that it contributes to improving the prognosis and management of the patients. However, more prospective studies are needed to demonstrate the accuracy of SCC.

Not all patients with convulsive status epilepticus intubated in pre-hospital settings meet the criteria for refractory status epilepticus

Seizure ◽  
2021 ◽  
Vol 88 ◽  
pp. 29-35
Author(s):  
Sinead Zeidan ◽  
Benjamin Rohaut ◽  
Hervé Outin ◽  
Francis Bolgert ◽  
Marion Houot ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Convulsive Status Epilepticus ◽  
Refractory Status
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