Predictors of Nonconvulsive Seizure and Their Effect on Short-term Outcome.
Journal
Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society
ISSN: 1537-1603
Titre abrégé: J Clin Neurophysiol
Pays: United States
ID NLM: 8506708
Informations de publication
Date de publication:
01 May 2021
01 May 2021
Historique:
pubmed:
7
3
2020
medline:
23
6
2021
entrez:
7
3
2020
Statut:
ppublish
Résumé
Nonconvulsive seizures (NCSs) are common in critically ill adult patients with acute neurologic conditions. However, the effect of NCSs on patient outcome remains unclear. In this study, we aimed to determine the effect of NCSs on short-term outcome and to assess the clinical and EEG factors associated with NCSs. We retrospectively identified 219 adult patients from the EEG reporting system who underwent continuous EEG (cEEG) monitoring between January 2018 and June 2018. Patients with anoxic brain injury were excluded from the study. Clinical, laboratory, and EEG data were reviewed to determine potentially predictive factors of NCSs. The impact of NCSs on in-hospital mortality, length of stay, and disability on discharge was measured; an modified Rankin scale of three or greater was considered disabled. Of the 219 patients included in our study, a total of 14% (n = 31) had NCSs on continuous EEG, of which 42% (n = 13) had their first seizure discharge recorded during the first hour of continuous EEG monitoring. The presence of clinical seizures before continuous EEG (odds ratio = 1.787; 95% confidence interval = 1.197-2.667, P = 0.0045), history of epilepsy (odds ratio = 1.508; 95% confidence interval = 1.027-2.215, P = 0.035), and comatose state (29 vs. 16%; P = 0.0006) were associated with NCSs. Among EEG characteristics, the presence of interictal epileptiform discharges (P < 0.0001), lateralized rhythmic delta activity (P = 0.02), and lateralized periodic discharges (P < 0.0001) were associated with NCSs. Nonconvulsive seizures were significantly associated with longer in-hospital stay (23.68 ± 24.84 vs. 17.14 ± 20.52; P = 0.036) and disability on discharge (87% [n = 27] vs. 13% [n = 4], P = 0.02). However, there was no significant association between NCS and in-hospital mortality (9.6% [n = 3] vs. 10.6% [n = 20]; P = 0.1). Nonconvulsive seizures are associated with longer in-hospital stay and disability on discharge but not with in-hospital mortality in adult patients.
Identifiants
pubmed: 32141985
pii: 00004691-202105000-00012
doi: 10.1097/WNP.0000000000000687
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
221-225Informations de copyright
Copyright © 2020 by the American Clinical Neurophysiology Society.
Déclaration de conflit d'intérêts
J. Britton: co-investigator in clinical trials for GW Pharma and Grifols Pharmaceuticals; consultant UCB Pharmaceuticals. The remaining authors have no conflicts of interest to disclose.
Références
Claassen J, Taccone FS, Horn P, Holtkamp M, Stocchetti N, Oddo M. Recommendations on the use of EEG monitoring in critically ill patients: consensus statement from the neurointensive care section of the ESICM. Intensive Care Med 2013;39:1337–1351.
Towne AR, Waterhouse EJ, Boggs JG, et al. Prevalence of nonconvulsive status epilepticus in comatose patients. Neurology 2000;54:340–345.
Young GB, Doig GS. Continuous EEG monitoring in comatose intensive care patients: epileptiform activity in etiologically distinct groups. Neurocrit Care 2005;2:5–10.
Oddo M, Carrera E, Claassen J, Mayer SA, Hirsch LJ. Continuous electroencephalography in the medical intensive care unit. Crit Care Med 2009;37:2051–2056.
Vespa PM, Miller C, McArthur D, et al. Nonconvulsive electrographic seizures after traumatic brain injury result in a delayed, prolonged increase in intracranial pressure and metabolic crisis. Crit Care Med 2007;35:2830–2836.
DeGiorgio CM, Correale JD, Gott PS, et al. Serum neuron-specific enolase in human status epilepticus. Neurology 1995;45:1134–1137.
Young GB, Jordan KG, Doig GS. An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology 1996;47:83–89.
Topjian AA, Gutierrez-Colina AM, Sanchez SM, et al. Electrographic status epilepticus is associated with mortality and worse short-term outcome in critically ill children. Crit Care Med 2013;41:215–223.
Sutter R, Kaplan PW. Electroencephalographic criteria for nonconvulsive status epilepticus: synopsis and comprehensive survey. Epilepsia 2012;53(suppl 3):1–51.
Beniczky S, Hirsch LJ, Kaplan PW, et al. Unified EEG terminology and criteria for nonconvulsive status epilepticus. Epilepsia 2013;54(suppl 6):28–29.
Leitinger M, Beniczky S, Rohracher A, et al. Salzburg consensus criteria for non-convulsive status epilepticus—approach to clinical application. Epilepsy Behav 2015;49:158–163.
Canas N, Delgado H, Silva V, et al. The electroclinical spectrum, etiologies, treatment and outcome of nonconvulsive status epilepticus in the elderly. Epilepsy Behav 2018;79:53–57.
Delorenzo RJ, Waterhouse EJ, Towne AR, et al. Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia 1998;39:833–840.
Narayanan JT, Murthy JM. Nonconvulsive status epilepticus in a neurological intensive care unit: profile in a developing country. Epilepsia 2007;48:900–906.
Litt B, Wityk RJ, Hertz SH, et al. Nonconvulsive status epilepticus in the critically ill elderly. Epilepsia 1998;39:1194–1202.
Abend NS, Arndt DH, Carpenter JL, et al. Electrographic seizures in pediatric ICU patients: cohort study of risk factors and mortality. Neurology 2013;81:383–391.
Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology 2004;62:1743–1748.
Singh J, Britton J, Alwaki A, Singh P. After-hours EEG: relative value of emergent routine versus prolonged EEG recordings. J Clin Neurophysiol 2019;36:32–35.
Rodriguez Ruiz A, Vlachy J, Lee JW, et al. Association of periodic and rhythmic electroencephalographic patterns with seizures in critically ill patients. JAMA Neurol 2017;74:181–188.
Ishikawa N, Kobayashi Y, Fujii Y, et al. Increased interleukin-6 and high-sensitivity C-reactive protein levels in pediatric epilepsy patients with frequent, refractory generalized motor seizures. Seizure 2015;25:136–140.
Alapirtti T, Waris M, Fallah M, et al. C-reactive protein and seizures in focal epilepsy: a video-electroencephalographic study. Epilepsia 2012;53:790–796.
Gouveia TL, Vieira de Sousa PV, de Almeida SS, et al. High serum levels of proinflammatory markers during epileptogenesis. Can omega-3 fatty acid administration reduce this process?. Epilepsy Behav 2015;51:300–305.
Sutter R, Grize L, Fuhr P, et al. Acute-phase proteins and mortality in status epilepticus: a 5-year observational cohort study. Crit Care Med 2013;41:1526–1533.
Özdemir HH, Akil E, Acar A, et al. Changes in serum albumin levels and neutrophil-lymphocyte ratio in patients with convulsive status epilepticus. Int J Neurosci 2017;127:417–420.
Scramstad C, Jackson AC. Cerebrospinal fluid pleocytosis in critical care patients with seizures. Can J Neurol Sci 2017;44:343–349.
Shneker BF, Fountain NB. Assessment of acute morbidity and mortality in nonconvulsive status epilepticus. Neurology 2003;61:1066–1073.
Spatola M, Novy J, Pasquier RD, Dalmau J, Rossetti AO. Status epilepticus of inflammatory etiology. Neurology 2015;85:464–470.
Laccheo I, Sonmezturk H, Bhatt A, et al. Non-convulsive status epilepticus and non-convulsive seizures in neurological ICU patients. Neurocrit Care 2015;22:202–211.
Vezzani A, French J, Bartfai T, Baram TZ. The role of inflammation in epilepsy. Nat Rev Neurol 2011;7:31–40.
Xiong ZQ, Qian W, Suzuki K, McNamara JO. Formation of complement membrane attack complex in mammalian cerebral cortex evokes seizures and neurodegeneration. J Neurosci 2003;23:955–960.
Jun JS, Lee ST, Kim R, Chu K, Lee SK. Tocilizumab treatment for new onset refractory status epilepticus. Ann Neurol 2018;84:940–945.
Kenney-Jung DL, Vezzani A, Kahoud RJ, et al. Febrile infection-related epilepsy syndrome treated with anakinra. Ann Neurol 2016;80:939–945.