An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring

Abstract

Of 49 patients with nonconvulsive seizures studied with continuous EEG monitoring, the overall mortality was 33% (16/49). Of the 23 patients with nonconvulsive status epilepticus (NCSE), 13 died (mortality 57%). Individual variables significantly associated with mortality were age, presence of NCSE, seizure duration, hospital and NICU length of stay, and delay to diagnosis and etiology (acute illness versus remote symptomatic). With multivariate logistic regression, only seizure duration (p = 0.0057, OR = 1.131/hour) and delay to diagnosis (p = 0.0351, OR = 1.039/hour) were associated with increased mortality. Acute symptomatic cases could not be adequately classified as either absence, simple, or complex partial status epilepticus when the impairment of consciousness arose form the initial illness. Current classifications of status epilepticus are inadequate for such cases.

Alpha-chloralose is a suitable anesthetic for chronic focal cerebral ischemia studies in the rat: A comparative study

“…The incidence of NCS in this model is 81%, the mean number of NCS/animal is 10.6 over a 2 hour observation period, and the mean duration of each episode is 60 sec (Hartings et al, 2003b). The occurrence and duration of NCS in brain injured patients are critical determinants of outcome and mortality (Jordan, 1995;Litt et al, 1998;Young et al, 1996). Although electric seizures and acute brain injury work synergistically to worsen outcome, the underlying pathomechanism is still unclear.…”

Non-convulsive status epilepticus in the postanesthesia care unit following meningioma excision

“…Even so, in some cases, excessive and overly aggressive treatment of seizures has also been reported to result in worsening of outcomes. 10 Several studies in animals have clearly shown the importance of treating non-convulsive seizures, which may be associated with increased metabolic, oxidative, and excitotoxic stress on brain at-risk, [13][14][15] and thus may result in irreversible neuronal injury. The management of NCSE is less clear in patients in whom NCSE presents as a manifestation of a serious underlying illness.…”

Early withdrawal of non-anesthetic antiepileptic drugs after successful termination of nonconvulsive seizures and nonconvulsive status epilepticus

“…The incidence of NCS and NCSE ranges between 8 and 48% depending on the patient population studied [1][2][3][4][5][6][7][8]. The mortality rate of neurologically critically ill patients afflicted with NCSE is 18-57% [9,10] while the presence of NCS is associated with a mortality rate of 33% [10]. Although the presence of NCS does not independently affect mortality, it has been found that the duration of NCS is associated with an increase in mortality [10] and that increasing seizure burden worsens cognitive and functional outcomes [11].…”

“…The mortality rate of neurologically critically ill patients afflicted with NCSE is 18-57% [9,10] while the presence of NCS is associated with a mortality rate of 33% [10]. Although the presence of NCS does not independently affect mortality, it has been found that the duration of NCS is associated with an increase in mortality [10] and that increasing seizure burden worsens cognitive and functional outcomes [11]. Therefore, prompt identification and appropriate treatment are essential, requiring CCEEG monitoring since seizures are nonconvulsive in 92% of critically ill patients whose hospital course is complicated by NCS or NCSE [1].…”