Non-convulsive seizures in the encephalopathic critically ill cancer patient does not necessarily portend a poor prognosis.
Cancer
Critically ill
Encephalopathy
Mortality
Non-convulsive seizures
Status epilepticus
Journal
Journal of intensive care
ISSN: 2052-0492
Titre abrégé: J Intensive Care
Pays: England
ID NLM: 101627304
Informations de publication
Date de publication:
2019
2019
Historique:
received:
24
07
2019
accepted:
19
11
2019
entrez:
1
1
2020
pubmed:
1
1
2020
medline:
1
1
2020
Statut:
epublish
Résumé
Non-convulsive status epilepticus (NCSE) is present in 10-30% of ICU patients with altered mental status (AMS) and is associated to poor outcomes. To our knowledge, there is no data describing the prevalence and outcomes of critically ill cancer patients with AMS associated to non-convulsive seizures (NCS) or NCSE. We aim to describe the outcomes and risk factors of critically ill cancer patients with encephalopathy associated with non-convulsive seizures (NCS). This is a 3-year prospective observational study in a mixed oncological ICU at MD Anderson Cancer Center. Data of ICU patients with moderate to severe encephalopathy (Glasgow Coma Score < 13) that underwent EEG monitoring to rule out NCS were collected. Multivariate logistic regression was performed to identify risk factors and outcomes. Of the 317 patients with encephalopathy who underwent EEG monitoring, 14.5% had NCS. Known risk factors such as sepsis, CNS infection, antibiotics, and cardiac arrest were not associated with increased risk of NCS. Patients with NCS were more likely to have received recent chemotherapy (41.3% vs 21.4%; NCS in critically ill cancer patients is associated with abnormalities on brain imaging and lower prevalence of organ failure. Diagnosis and treatment of NCS should be a priority in encephalopathic cancer patients, as they can have lower mortality than non-seizing patients. Opposite to other populations, NCS should not be considered a poor prognostic factor in critically ill encephalopathic cancer patients as they reflect a reversible cause for altered mentation.
Sections du résumé
BACKGROUND
BACKGROUND
Non-convulsive status epilepticus (NCSE) is present in 10-30% of ICU patients with altered mental status (AMS) and is associated to poor outcomes. To our knowledge, there is no data describing the prevalence and outcomes of critically ill cancer patients with AMS associated to non-convulsive seizures (NCS) or NCSE. We aim to describe the outcomes and risk factors of critically ill cancer patients with encephalopathy associated with non-convulsive seizures (NCS).
METHODS
METHODS
This is a 3-year prospective observational study in a mixed oncological ICU at MD Anderson Cancer Center. Data of ICU patients with moderate to severe encephalopathy (Glasgow Coma Score < 13) that underwent EEG monitoring to rule out NCS were collected. Multivariate logistic regression was performed to identify risk factors and outcomes.
RESULTS
RESULTS
Of the 317 patients with encephalopathy who underwent EEG monitoring, 14.5% had NCS. Known risk factors such as sepsis, CNS infection, antibiotics, and cardiac arrest were not associated with increased risk of NCS. Patients with NCS were more likely to have received recent chemotherapy (41.3% vs 21.4%;
CONCLUSIONS
CONCLUSIONS
NCS in critically ill cancer patients is associated with abnormalities on brain imaging and lower prevalence of organ failure. Diagnosis and treatment of NCS should be a priority in encephalopathic cancer patients, as they can have lower mortality than non-seizing patients. Opposite to other populations, NCS should not be considered a poor prognostic factor in critically ill encephalopathic cancer patients as they reflect a reversible cause for altered mentation.
Identifiants
pubmed: 31890224
doi: 10.1186/s40560-019-0414-0
pii: 414
pmc: PMC6915900
doi:
Types de publication
Journal Article
Langues
eng
Pagination
62Informations de copyright
© The Author(s). 2019.
Déclaration de conflit d'intérêts
Competing interestsThe authors declare that they have no competing interests.
Références
J Biomed Inform. 2009 Apr;42(2):377-81
pubmed: 18929686
Intensive Care Med. 2014 Feb;40(2):228-34
pubmed: 24240843
Neurol Sci. 2013 Mar;34(3):327-31
pubmed: 22395944
J Crit Care. 2016 Aug;34:146-53
pubmed: 27067289
J Clin Neurophysiol. 2017 Mar;34(2):158-161
pubmed: 27571047
Crit Care Resusc. 2015 Dec;17(4):268-73
pubmed: 26640063
Semin Neurol. 2008 Jul;28(3):342-54
pubmed: 18777481
Arch Neurol. 2001 Aug;58(8):1310
pubmed: 11493178
Epileptic Disord. 2014 Dec;16(4):439-48
pubmed: 25498516
Epilepsia. 2015 Aug;56(8):1309-13
pubmed: 26073612
Intensive Care Med. 2019 Jul;45(7):977-987
pubmed: 31143998
Crit Care Med. 2009 Jun;37(6):2051-6
pubmed: 19384197
Epilepsy Res. 2011 Sep;96(1-2):140-50
pubmed: 21676592
Arch Neurol. 2000 Dec;57(12):1727-31
pubmed: 11115238
J Med Assoc Thai. 2016 Sep;99 Suppl 6:S233-S241
pubmed: 29906385
Crit Care Med. 2018 Sep;46(9):1402-1410
pubmed: 29939878
Hematol Oncol Clin North Am. 2010 Jun;24(3):515-35
pubmed: 20488351
J Clin Neurophysiol. 2013 Aug;30(4):339-43
pubmed: 23912570
Intensive Care Med. 2007 Jun;33(6):941-50
pubmed: 17410344
Neurocrit Care. 2015 Apr;22(2):202-11
pubmed: 25246236
Crit Care Med. 2016 May;44(5):926-33
pubmed: 26765498
Lancet Neurol. 2006 Mar;5(3):246-56
pubmed: 16488380
Nat Rev Clin Oncol. 2018 Jan;15(1):47-62
pubmed: 28925994
Intensive Care Med. 2015 Apr;41(4):686-94
pubmed: 25763756
J Neurooncol. 2016 Mar;127(1):111-7
pubmed: 26608523
Intensive Care Med. 2013 Aug;39(8):1337-51
pubmed: 23653183
JAMA. 2001 Oct 10;286(14):1754-8
pubmed: 11594901
Curr Oncol Rep. 2008 Jan;10(1):63-71
pubmed: 18366962
Epilepsia. 2007 Apr;48(4):732-42
pubmed: 17319915
Neurology. 2015 Oct 13;85(15):1332-41
pubmed: 26400582
Epilepsy Behav. 2015 Aug;49:250-4
pubmed: 26198216
Crit Care Med. 2018 Mar;46(3):465-470
pubmed: 29474329
Neurology. 2004 May 25;62(10):1743-8
pubmed: 15159471
Epilepsy Behav. 2015 Aug;49:158-63
pubmed: 26092326