A study on the clinical and electrographic profile of Nonconvulsive Status Epilepticus (NCSE) in comatose ICU patients using portable electroencephalography (EEG)

Anadure, Ravi; Goel, J.; Sαxena, R. S.; Gupta, Salil; Vidhale, Tushar

doi:10.1016/j.mjafi.2021.06.027

Cited by 3 publications

(5 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our study has also found the prevalence of any seizure activity and NCSE to be high (42.9% and 28.8%, respectively) 1,5,18 . NCSE was present in 58.9% of patients in whom any seizure activity was detected.…”

Section: Discussionsupporting

confidence: 69%

“…Our study has also found the prevalence of any seizure activity and NCSE to be high (42.9% and 28.8%, respectively). 1,5,18 NCSE was present in 58.9% of patients in whom any seizure activity was detected. The high prevalence of NCSE found in our study can be used to safely assume that their detection can be enhanced with the use of bedside EEGs.…”

Section: Discussionmentioning

confidence: 96%

“…Across the various etiologies of altered mental status, electroencephalographic (EEG) abnormalities are increasingly being reported to be more common than previously thought 1–3 . In patients with altered sensorium or coma, the prevalence of non‐convulsive status epilepticus (NCSE) has been found to range from 8% to 40% depending on the population type and the duration of EEG examination that is, continuous or 30‐min examination 1,4–7 . These EEG abnormalities, especially non convulsive seizures (NCS) and NCSE have been linked unfavorably to patient outcomes in terms of length of ICU stay, length of hospital stay, morbidity, and even mortality 5,8–12 .…”

Section: Introductionmentioning

confidence: 99%

“… 1 , 2 , 3 In patients with altered sensorium or coma, the prevalence of non‐convulsive status epilepticus (NCSE) has been found to range from 8% to 40% depending on the population type and the duration of EEG examination that is, continuous or 30‐min examination. 1 , 4 , 5 , 6 , 7 These EEG abnormalities, especially non convulsive seizures (NCS) and NCSE have been linked unfavorably to patient outcomes in terms of length of ICU stay, length of hospital stay, morbidity, and even mortality. 5 , 8 , 9 , 10 , 11 , 12 But because of their undramatic, non‐convulsive nature with only a few if any subtle clinical signs, they are often not diagnosed, or diagnosed very late during the course of treatment.…”

Section: Introductionmentioning

confidence: 99%

“… 1 , 4 , 5 , 6 , 7 These EEG abnormalities, especially non convulsive seizures (NCS) and NCSE have been linked unfavorably to patient outcomes in terms of length of ICU stay, length of hospital stay, morbidity, and even mortality. 5 , 8 , 9 , 10 , 11 , 12 But because of their undramatic, non‐convulsive nature with only a few if any subtle clinical signs, they are often not diagnosed, or diagnosed very late during the course of treatment. 13 Studies have found delays of as much as 24 h in detecting the first seizure activity during sessions of continuous EEG monitoring.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Prevalence of non‐convulsive seizures and electroencephalographic abnormalities in critically ill patients—A retrospective observational study

Karki,

Shrestha,

Shrestha

et al. 2023

Epilepsia Open

View full text Add to dashboard Cite

ObjectiveElectroencephalographic (EEG) abnormalities especially non‐convulsive status epilepticus (NCSE) have been found to be associated with worse outcomes in critically ill patients. We aimed to assess the prevalence of non‐convulsive seizures and electroencephalographic abnormalities in critically ill patients. Furthermore, we aimed to investigate any association between the type of EEG abnormality and outcomes including ICU mortality and successful ICU discharge.MethodsThis was a cross‐sectional observational study carried out among critically ill patients in a mixed medical‐surgical ICU from January 1, 2018 to May 15, 2020. A total of 178 records of 30 min bedside EEG records were found. EEG findings were grouped as normal, non‐convulsive seizures (NCS), non‐convulsive status epilepticus (NCSE), and other abnormalities. Descriptive analytical tools were used to characterize the case details in terms of the type of EEG abnormalities. Chi square test was used to describe the EEG abnormalities in terms of mortality. The status epilepticus severity scores (STESS) were further calculated for records with NCSE. These data were then analyzed for any association between STESS and mortality for cases with NCSE.ResultsThe prevalence of EEG abnormality in our cohort of all critically ill patients was found to be 7.3% (170/2234). Among the patients with altered sensorium in whom EEG was done, 42.9% had non‐conclusive seizure activity with 25.2% in NCSE. Though the study was not adequately powered, there was a definite trend towards a lower proportion of successful ICU discharge rates seen among patients with higher STESS (>2) with only 33.3% being discharged for patients with a STESS of 6 versus 92.9% for those with STESS 3.SignificanceWhen combined with a strong clinical suspicion, even a 30‐min bedside EEG can result in detection of EEG abnormalities including NCS and NCSE. Hence, EEG should be regularly included in the evaluation of critically ill patients with altered sensorium.Plain Language SummaryElectroencephalographic (EEG) abnormalities and seizures can have high prevalence in critically ill patients. These abnormalities notably, non‐convulsive status epilepticus (NCSE) has been found to be associated with poor patient outcomes. This was a retrospective observational study analyzing 178 EEG records, from a mixed medical‐surgical ICU. The indication for obtaining an EEG was based solely on the clinical suspicion of the treating physician. The study found a high prevalence of EEG abnormalities in 96.5% in whom it was obtained with 42.9% having any seizure activity and 28.8% having NCSE. The study was not powered for detection of association of the EEG abnormalities with clinical outcomes. However, a definite trend towards decreased chances of successful discharge from the ICU was seen. This study used strong clinical suspicion in patients with altered sensorium to obtain an EEG. High detection rates of EEG abnormalities were recorded in this study. Hence, combination of clinical judgement and EEG can improve detection of EEG abnormalities and NCSE.

show abstract

Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 96%