Diagnostic accuracy of the Salzburg EEG criteria for non-convulsive status epilepticus: a retrospective study

Leitinger, Markus; Trinka, Eugen; Gardella, Elena; Rohracher, Alexandra; Kalss, Gudrun; Qerama, Erisela; Höfler, Julia; Heß, Alexander; Zimmermann, Georg; Kuchukhidze, Giorgi; Dobesberger, Judith; Langthaler, Patrick B.; Beniczky, Sándor

doi:10.1016/s1474-4422(16)30137-5

Cited by 225 publications

(219 citation statements)

References 29 publications

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“…She presented to the ED with focal seizures and altered mental status following an episode of generalized convulsive seizures at home. This presentation could have been misdiagnosed as a postictal state, but her previous history of NCSE along with an EEG showing rhythmic 2.0- to 2.5-Hz delta meeting the Salzburg criteria [20] led to the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Transition from intravenous to enteral ketamine for treatment of nonconvulsive status epilepticus

et al. 2017

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BackgroundNonconvulsive status epilepticus (NCSE) is a diagnosis that is often challenging and one that may progress to refractory NCSE. Ketamine is a noncompetitive N-methyl-d-aspartate antagonist that increasingly has been used to treat refractory status epilepticus. Current Neurocritical Care Society guidelines recommend intravenous (IV) ketamine infusion as an alternative treatment for refractory status epilepticus in adults. On the other hand, enteral ketamine use in NCSE has been reported in only 6 cases (1 adult and 5 pediatric) in the literature to date.Case presentationA 33-year-old woman with a history of poorly controlled epilepsy presented with generalized tonic-clonic seizures, followed by recurrent focal seizures that evolved into NCSE. This immediately recurred within 24 h of a prior episode of NCSE that was treated with IV ketamine. Considering her previous response, she was started again on an IV ketamine infusion, which successfully terminated NCSE. This time, enteral ketamine was gradually introduced while weaning off the IV formulation. Treatment with enteral ketamine was continued for 6 months and then tapered off. There was no recurrence of NCSE or seizures and no adverse events noted during the course of treatment.ConclusionThis case supports the use of enteral ketamine as a potential adjunct to IV ketamine in the treatment of NCSE, especially in cases without coma. Introduction of enteral ketamine may reduce seizure recurrence, duration of stay in ICU, and morbidity associated with intubation.

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Section: Discussionmentioning

confidence: 99%

Transition from intravenous to enteral ketamine for treatment of nonconvulsive status epilepticus

et al. 2017

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To the Editors:

We have read with great interest the paper entitled, "The difficulty of diagnosing NCSE in clinical practice; external validation of the Salzburg criteria" by Goselink et al 1 We agree on the importance of "careful weighing of both clinical and EEG information on an individual basis," 1 which we have also emphasized in papers describing the Salzburg criteria for nonconvulsive status epilepticus (NCSE). [2][3][4] However, we have several comments on the methods and reporting of the study, which question the conclusions of the authors.

| STATISTICSThe authors found highly significant, yet moderate Spearman correlations (r s = 0.41, P < .001) between raters. Gwet AC1 coefficient might be a more appropriate method for assessment of interrater agreement, 8 as Spearman correlations could yield paradoxical results, similar to Cohen kappa.

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confidence: 88%

“…1 It is well documented that continuous EEG recordings 5,6 and repeated short-duration recordings increase the sensitivity of EEG in NCSE and in comatose patients. 4 It seems that the authors missed an important element of the Salzburg criteria: assessment of the modulatory effect of intravenous (IV) antiepileptic drugs (AEDs) on the EEG. 4 It seems that the authors missed an important element of the Salzburg criteria: assessment of the modulatory effect of intravenous (IV) antiepileptic drugs (AEDs) on the EEG.…”

Section: Sensitivit Ymentioning

confidence: 99%

Salzburg criteria for nonconvulsive status epilepticus: Details matter

et al. 2019

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To the Editors:We have read with great interest the paper entitled, "The difficulty of diagnosing NCSE in clinical practice; external validation of the Salzburg criteria" by Goselink et al. 1 We agree on the importance of "careful weighing of both clinical and EEG information on an individual basis," 1 which we have also emphasized in papers describing the Salzburg criteria for nonconvulsive status epilepticus (NCSE). [2][3][4] However, we have several comments on the methods and reporting of the study, which question the conclusions of the authors. | STATISTICSThe authors found highly significant, yet moderate Spearman correlations (r s = 0.41, P < .001) between raters. Gwet AC1 coefficient might be a more appropriate method for assessment of interrater agreement, 8 as Spearman correlations could yield paradoxical results, similar to Cohen kappa. There were only four cases of disagreement in 191 EEGs, so the interrater agreement should be good.Confidence intervals were not provided. This contradicts the very basic principles of reporting (item 24, STARD criteria 9 ). Given the moderate subgroup sizes and the resulting considerable variance, the strong conclusions are questionable from a methodological point of view.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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“…A recent study has shown that zonisamide is non-inferior to carbamazepine in new onset focal epilepsy in adults [109]. A large study of 1688 new onset patients compared time to withdrawal of levetiracetam in two arms to first choice carbamazepine or valproate in monotherapy in adults [110]. Overall, the drugs performed similarly but in a post hoc analysis, levetiracetam withdrawal rate was lower in those over 60, especially in comparison to carbamazepine, with fewer adverse effects rather than greater efficacy [111].…”

Section: Antiepileptic Drug Trialsmentioning

confidence: 99%

Recent advances in epilepsy

2017

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This paper reviews advances in epilepsy in recent years with an emphasis on therapeutics and underlying mechanisms, including status epilepticus, drug and surgical treatments. Lessons from rarer epilepsies regarding the relationship between epilepsy type, mechanisms and choice of antiepileptic drugs (AED) are explored and data regarding AED use in pregnancy are reviewed. Concepts evolving towards a move from treating seizures to treating epilepsy are discussed, both in terms of the mechanisms of epileptogenesis, and in terms of epilepsy’s broader comorbidity, especially depression.

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Diagnostic accuracy of the Salzburg EEG criteria for non-convulsive status epilepticus: a retrospective study

Cited by 225 publications

References 29 publications

Transition from intravenous to enteral ketamine for treatment of nonconvulsive status epilepticus

Transition from intravenous to enteral ketamine for treatment of nonconvulsive status epilepticus

Salzburg criteria for nonconvulsive status epilepticus: Details matter

Recent advances in epilepsy

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