Duration of epileptic seizure types: A data‐driven approach

Larsen, Pirgit Meritam; Wüstenhagen, Stephan; Terney, Daniella; Gardella, Elena; Aurlien, Harald; Beniczky, Sándor

doi:10.1111/epi.17492

Cited by 18 publications

(23 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Indeed, even in down‐titrated patients, there could still be some seizure‐shortening effect by the ASM. However, it should be noted that seizures' length in our epilepsy group is in line with data reported from previous studies 3–5 (see Figure 2).…”

Section: Study Limitationssupporting

confidence: 93%

“…For each seizure, the duration was calculated by EEG visual inspection and defined as the time between the first EEG modification and the end of ictal activity. In particular, EEG seizure duration was defined as the time between the initial transition from background activity to focal ictal activity and the cessation of that activity/initiation of postictal EEG activity (suppression or slowing) 5 . Examples of recorded seizure onset patterns are shown in Figure S1.…”

Section: Methodsmentioning

confidence: 99%

“…As recently reported, the duration of various epileptic seizure types is an important information, with high clinical relevance 5 . Knowing the upper limit of seizure duration for different seizure types is critical for the early identification of patients at risk for SE 2,5 …”

Section: Introductionmentioning

confidence: 99%

“…Currently, t1 is set at 300 s for tonic–clonic SE and at 600 s for focal SE with impaired awareness. The data leading to the current definition are based on studies that analyzed seizure durations in patients admitted to epilepsy monitoring units or to elective video‐EEG recordings 3–5 . As recently reported, the duration of various epileptic seizure types is an important information, with high clinical relevance 5 .…”

Section: Introductionmentioning

confidence: 99%

“…The data leading to the current definition are based on studies that analyzed seizure durations in patients admitted to epilepsy monitoring units or to elective video‐EEG recordings 3–5 . As recently reported, the duration of various epileptic seizure types is an important information, with high clinical relevance 5 . Knowing the upper limit of seizure duration for different seizure types is critical for the early identification of patients at risk for SE 2,5 …”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Electrographic seizure duration and inter‐seizure intervals in focal status epilepticus

Meletti

Turchi

Orlandi

et al. 2023

Epileptic Disorders

View full text Add to dashboard Cite

ObjectiveTo characterize the duration of seizures and inter‐seizure intervals in focal status epilepticus (SE).MethodsWe reviewed consecutive scalp EEG recordings from adult patients who were admitted for a first episode of focal status epilepticus. We identified electrographic seizure duration and inter‐seizure intervals in the first diagnostic pretreatment EEG. We also reviewed isolated focal self‐limiting seizures in epilepsy patients, as a comparison group for seizure duration.ResultsWe recorded 307 focal seizures in 100 consecutive focal SE episodes, with a median seizure duration of 107 s (IQR: 54–186), and 134 isolated focal self‐limiting seizures in 42 epilepsy patients, with a median duration of 59 s (IQR: 30–90; p < .001). The only clinical feature of SE that significantly increased seizure duration was acute symptomatic etiology. In SE, 15% and 7% of seizures lasted longer than 300 and 600 s, respectively (t1 of the actual definition for tonic–clonic and focal SE), while only 1% of self‐limiting seizures lasted longer than 300 s, and none lasted longer than 600 s. The analysis of inter‐seizure intervals in SE with multiple seizures showed that 50% of the inter‐seizure periods were shorter than 60 s, and 95% were shorter than 540 s (9 min). Patients who had an increase in seizure duration (last versus first) of at least 1.4 times showed an increased 30‐day mortality.SignificanceFocal seizures within a SE episode showed a wide range of duration, partly overlapping with the duration of focal self‐limiting seizures but with a longer median duration. Inter‐seizure intervals within an episode of SE were shorter than 1 min in 50% of the seizures and never lasted more than 10 min. Finally, an increase in seizure duration could represent an “electrophysiological biomarker” of a more severe SE episode, which may require more aggressive and rapid treatment.

show abstract

Section: Study Limitationssupporting

confidence: 93%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Electrographic seizure duration and inter‐seizure intervals in focal status epilepticus

Meletti

Turchi

Orlandi

et al. 2023

Epileptic Disorders

View full text Add to dashboard Cite

show abstract

Outpatient management of prolonged seizures and seizure clusters to prevent progression to a higher‐level emergency: Consensus recommendations of an expert working group

Pina‐Garza,

Chez,

Cloyd

et al. 2024

Epileptic Disorders

View full text Add to dashboard Cite

ObjectiveThe management of prolonged seizures (PS) and seizure clusters (SC) is impeded by the lack of international, evidence‐based guidance. We aimed to develop expert recommendations regarding consensus definitions of PS, SC, and treatment goals to prevent progression to higher‐level emergencies such as status epilepticus (SE).MethodsAn expert working group, comprising 12 epileptologists, neurologists, and pharmacologists from Europe and North America, used a modified Delphi consensus methodology to develop and anonymously vote on statements. Consensus was defined as ≥75% voting “Agree”/”Strongly agree.”ResultsAll group members strongly agreed that termination of an ongoing seizure in as short a time as possible is the primary goal of rapid and early seizure termination (REST) and that an ideal medication for REST would start to act within 2 min of administration to terminate ongoing seizure activity. Consensus was reached on the terminology defining PS (with proposed thresholds of 5 min for prolonged focal seizures and 2 min for prolonged absence seizures and the convulsive phase of bilateral tonic‐clonic seizures) and SC (an abnormal increase in seizure frequency compared with the individual patient's usual seizure pattern). All group members strongly agreed or agreed that patients who have experienced a PS should be offered a REST medication, and all patients who have experienced a SC should be offered an acute cluster treatment (ACT). Further, when prescribing a REST medication or ACT, a seizure action plan should be agreed upon in consultation with the patient and caregiver.SignificanceThe expert working group had a high level of agreement on the recommendations for defining and managing PS and SC. These recommendations will complement the existing guidance for the management of acute seizures, with the possibility of treating them earlier to potentially avoid progression to more severe seizures, including SE.

show abstract

Rapid Rescue Treatment with Diazepam Nasal Spray Leads to Faster Seizure Cluster Termination in Epilepsy: An Exploratory Post Hoc Cohort Analysis

Misra,

Jarrar,

Stern

et al. 2024

Neurol Ther

View full text Add to dashboard Cite

Introduction Although prompt treatment of status epilepticus is standard of care, the effect of timing of rescue therapy administration for seizure clusters in epilepsy remains unknown. Seizure clusters are a rare but clinically important condition, and benzodiazepines are the cornerstone rescue therapy for seizure clusters in epilepsy. We characterized temporal patterns from a large dataset of treated seizure clusters in the safety study of diazepam nasal spray. Methods This post hoc analysis used timing data of treated seizure clusters recorded by care partners and patients in seizure diaries during a 1-year safety study. Data analysis used time from seizure start to administration of diazepam. Results From 4466 observations, 3225 had data meeting criteria for analysis. Overall, median times from seizure start to dose administration, dose administration to seizure termination, and total seizure duration were 2, 3, and 7 min, respectively. In seizure clusters treated in < 5 min (median 1.0 min), median time from dose to seizure termination was 2.0 min, and median total seizure duration was 4.0 min. Among seizure clusters treated in ≥ 5 min (median 10.0 min), median time to seizure termination was 10.0 min, and median total seizure duration was 23.0 min. Previously published safety results reported that over a mean participation of 1.5 years, 82.2% of patients had ≥ 1 treatment-emergent adverse events (TEAEs) irrespective of relationship to treatment, including 30.7% with serious TEAEs; 18.4% had TEAEs deemed at least possibly related to the study drug, none of which were serious. There were no events of cardiorespiratory depression. Conclusion Echoing the importance of early use of benzodiazepines in status epilepticus, the findings from this exploratory analysis of patients with refractory epilepsy and frequent seizure clusters identify a potential benefit of early diazepam nasal spray treatment leading to faster seizure resolution within the seizure cluster. Trial Registration Information: ClinicalTrials.gov identifier NCT02721069 ( https://clinicaltrials.gov/ct2/show/NCT02721069 ). Supplementary Information The online version contains supplementary material available at 10.1007/s40120-023-00568-4.

show abstract

Duration of epileptic seizure types: A data‐driven approach

Cited by 18 publications

References 57 publications

Electrographic seizure duration and inter‐seizure intervals in focal status epilepticus

Electrographic seizure duration and inter‐seizure intervals in focal status epilepticus

Outpatient management of prolonged seizures and seizure clusters to prevent progression to a higher‐level emergency: Consensus recommendations of an expert working group

Rapid Rescue Treatment with Diazepam Nasal Spray Leads to Faster Seizure Cluster Termination in Epilepsy: An Exploratory Post Hoc Cohort Analysis

Contact Info

Product

Resources

About