Continuous EEG Monitoring in Patients With Subarachnoid Hemorrhage

Claassen, Jan; Mayer, Stephan A.; Hirsch, Lawrence J.

doi:10.1097/01.wnp.0000145006.02048.3a

Cited by 132 publications

(75 citation statements)

References 42 publications

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“…In our study cohort, 13.2% of patients presented with a seizure between initial ictus and discharge from the neurosurgical unit, which is consistent with previous reports. 3,4,11,13,20 Of these, 73.2% suffered their seizure in the early phase, including the prehospitalization period up to neurological resuscitation. The impact of EOS on outcome has been previously studied.…”

Section: Discussionmentioning

confidence: 99%

Impact of early-onset seizures on grading and outcome in patients with subarachnoid hemorrhage

Fung¹,

Balmer²,

Murek³

et al. 2015

JNS

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O n presentation at a neurosurgical-neurovascular center, patients suffering from aneurysmal subarachnoid hemorrhage (SAH) may exhibit a reduced level of consciousness due to initial bleeding, rebleeding, hydrocephalus, sedation, or seizure 1,9,15,20,22 as well as other conditions. Subarachnoid hemorrhage causes seizures in up to 26% of patients, which occur most commonly within the first 24 hours. 3,9,20,23 Most seizures occur before hospital presentation. 20 The severity of SAH, as graded on scales like the World Federation of Neurosurgical Societies (WFNS) scale, as well as intracerebral hemorrhage (ICH), localization of the aneurysm, and the amount of subarachnoid blood are important risk factors for the development of early seizures. obJect After subarachnoid hemorrhage (SAH), seizure occurs in up to 26% of patients. The impact of seizure on outcome has been studied, yet its impact on grading is unknown. The authors evaluated the impact of early-onset seizures (EOS) on grading of spontaneous SAH and on outcome. methods This retrospective analysis included consecutive patients with SAH who were treated at the NeuroCenter, Inselspital, University Hospital Bern, Switzerland, between January 2005 and December 2010. Demographic data, clinical data, and reports of EOS were recorded. The EOS were defined as seizures occurring within 24 hours after ictus. Patients were graded according to the World Federation of Neurosurgical Societies (WFNS) scale pre- and postresuscitation and dichotomized into good (WFNS I-III) and poor (WFNS IV-V) grades. Outcome was assessed at 6 months by using the modified Rankin Scale (mRS); an mRS score of 0-3 was considered a good outcome and an mRS score of 4-6 was considered a poor outcome. results Forty-one of 425 patients with SAH had EOS. Twenty-seven of those 41 patients (65.9%) had a poor WFNS grade. Twenty-eight (68.3%) achieved a good outcome, 11 (26.8%) had a poor outcome, and 2 (4.9%) were lost to followup. Early-onset seizures were proven in 9 of 16 electroencephalograms. The EOS were associated with poor WFNS grade (OR 2.81, 97.5% CI 1.14-7.46; p = 0.03) and good outcome (OR 4.01, 97.5% CI 1.63-10.53; p = 0.03). Increasing age, hydrocephalus, intracerebral hemorrhage, and intraventricular hemorrhage were associated with poor WFNS grade, whereas only age, intracerebral hemorrhage (p < 0.001), and poor WFNS grade (p < 0.001) were associated with poor outcome. coNclusioNs Patients with EOS were classified significantly more often in a poor grade initially, but then they significantly more often achieved a good outcome. The authors conclude that EOS can negatively influence grading. This might influence decision making for the care of patients with SAH, so grading of patients with EOS should be interpreted with caution.

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Section: Discussionmentioning

confidence: 99%

Impact of early-onset seizures on grading and outcome in patients with subarachnoid hemorrhage

Fung¹,

Balmer²,

Murek³

et al. 2015

JNS

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“…Risk factors for developing nonconvulsive status epilepticus include severe clinical presentation (Hunt and Hess grade IV or V), older age, and a focal pathologic lesions on computed tomographic imaging. In a separate cohort, 19% of patients undergoing EEG for SAH had documented seizures, almost all of which were nonconvulsive [19]. Because prophylactic anti-seizure medication is associated with worse outcome after SAH [20,21], routine prophylaxis at our center is reserved for patients with high-grade SAH at risk of re-rupture from seizure prior to aneurysmal obliteration.…”

Section: Patient Selectionmentioning

confidence: 99%

The Utility of EEG, SSEP, and Other Neurophysiologic Tools to Guide Neurocritical Care

Rosenthal

2012

Neurotherapeutics

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Neuromonitoring is an emerging field that aims to characterize real-time neurophysiology to tailor therapy for acute injuries of the central nervous system. While cardiac telemetry has been used for decades among patients requiring critical care of all kinds, neurophysiology and neurotelemetry has only recently emerged as a routine screening tool in comatose patients. The increasing utilization of electroencephalography in comatose patients is primarily due to the recognition of the common occurrence of nonconvulsive seizures among comatose patients, the development of quantitative measures to detect regional ischemia, and the appreciation of electroencephalography phenotypes that indicate prognosis after cardiac arrest. Other neuromonitoring tools, such as somatosensory evoked potentials have a complementary role, surveying the integrity of the neuroaxis as an indicator of prognosis or illness progression in both acute brain and spinal injuries.

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“…The reported incidence of clinical seizures is in the range of 0.2-27%, with the higher incidence in poor grade patients [13,19,[20][21][22][23]. A study on the occurrence of non-convulsive seizures (NCSZ) in poor grade SAH patients reported seizures in 18% of the patients [14]. Other studies have reported non-convulsive status epilepticus (NCSE) in 3 -31% of SAH patients [1,11,15] Detection of epileptic seizures is of importance since secondary brain injury is correlated to epileptic seizures [16,[24][25][26].…”

Section: Introductionmentioning

confidence: 99%

“…The cEEG can serve as a method to detect events, which may give rise to secondary brain injury such as cerebral vasospasm, ischemia and subclinical epileptic seizures [5][6][7][8][9][10]. Clinical seizures have been reported to occur in 8-43 %, and subclinical EEG seizures have been reported in 3-36 % of patients treated at neuro-intensive care units [11][12][13][14][15]. Clinical seizures are common in patients suffering from subarachnoid haemorrhage (SAH).…”

Section: Introductionmentioning

confidence: 99%

Frequency of Non-convulsive Seizures and Non-convulsive Status Epilepticus in Subarachnoid Hemorrhage Patients in Need of Controlled Ventilation and Sedation

et al. 2012

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Frequency of non-convulsive Seizures and non-convulsive status Epilepticus in SubarachnoidHemorrhage patients in need of controlled ventilation and sedation. Umeå UniversityThis is an accepted version of a paper published in Neurocritical Care. This paper has been peer-reviewed but does not include the final publisher proof-corrections or journal pagination.Citation for the published paper: Lindgren, C., Nordh, E., Naredi, S., Olivecrona, M. (2012 AbstractBackground: Non-convulsive seizures (NCSZ) can be more prevalent than previously recognized among comatose neuro-intensive care patients. The aim of this study was to evaluate the frequency of NCSZ and non-convulsive status epilepticus (NCSE) in sedated and ventilated subarachnoid haemorrhage (SAH) patients. Methods: Retrospective study at a university hospital neuro-intensive care unit, from January 2008 until June 2010. Patients were treated according to a local protocol, and were initially sedated with midazolam or propofol or combinations of these sedative agents. Thiopental was added for treatment of intracranial hypertension. No wake-up tests were performed. Using NicoletOne® equipment (VIASYS Healthcare Inc., U.S.A.), continuous EEG recordings based on four electrodes and a reference electrode was inspected at full length both in a two electrode bipolar and a four channel referential montage.Results: Approximately 5500 hours of continuous EEG were registered in 28 SAH patients (33% of the patients eligible for inclusion). The median Glasgow Coma scale was 8 (range 3-14) and the median Hunt & Hess score was 4 (range 1-4). During EEG registration no clinical seizures were observed. In none of the patients inter ictal epileptiform activity was seen. EEG seizures were recorded only in 2/28 (7%) patients. One of the patients experienced four minutes of a NCSZ and one had a five hours episode of a NCSE. Conclusion: Continuous EEG monitoring is important in detecting non-convulsive seizures in sedated patients. Continuous sedation, without wake-up tests, was associated with a low frequency of subclinical seizures in SAH patients in need of controlled ventilation.

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Continuous EEG Monitoring in Patients With Subarachnoid Hemorrhage

Cited by 132 publications

References 42 publications

Impact of early-onset seizures on grading and outcome in patients with subarachnoid hemorrhage

Impact of early-onset seizures on grading and outcome in patients with subarachnoid hemorrhage

The Utility of EEG, SSEP, and Other Neurophysiologic Tools to Guide Neurocritical Care

Frequency of Non-convulsive Seizures and Non-convulsive Status Epilepticus in Subarachnoid Hemorrhage Patients in Need of Controlled Ventilation and Sedation

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