Effects of epileptiform activity on discharge outcome in critically ill patients in the USA: a retrospective cross-sectional study

Parikh, Harsh; Hoffman, Kentaro; Sun, Haoqi; Zafar, Sahar F.; Ge, Wendong; Jin, Jing; Liu, Lin; Sun, Jimeng; Struck, Aaron F.; Volfovsky, Alexander; Rudin, Cynthia; Westover, M. Brandon

doi:10.1016/s2589-7500(23)00088-2

Cited by 10 publications

(27 citation statements)

References 25 publications

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“… 2 , 10 The study by Parikh and colleagues included not only electrographic seizures but also periodic discharges and LRDA. 3 Despite this relatively broad definition of EA, these authors noted a strong association with neurologic deterioration.…”

Section: Commentarymentioning

confidence: 99%

“…A recent study by Parikh and colleagues furthers our understanding of t 2 in critically ill patients with electrographic seizure activity. 3 These authors retrospectively evaluated the continuous EEG (cEEG) monitoring records of 995 critically ill patients. They determined the mean and maximum amount of electrographic epileptiform activity (EA) in the first 6 hours of cEEG and compared this to outcomes after accounting for covariates.…”

Section: Commentarymentioning

confidence: 99%

“…The study by Parikh and colleagues is the latest to add to the growing body of evidence that increasing seizure burden leads to worse neurologic outcomes in patients in SE. 3 Increasingly, seizure burden, as a measure EA per hour of cEEG, is being used to define the severity SE. Moreover, while the time point t 2 in NCSE was uncertain in 2015, growing evidence suggests that this may be around 10% to 20% (6-12 minutes per hour).…”

Section: Commentarymentioning

confidence: 99%

“…Finally, should the time points t 1 and t 2 not only depend on the semiology of the SE but also the etiology, with some like acute brain injury being more susceptible to the effects of EA? 3 , 7 The time is right for another reappraisal of our understanding of SE and how aggressively it should be treated.…”

Section: Commentarymentioning

confidence: 99%

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“T” Times: Revisiting the Timing of Neuronal Injury in Status Epilepticus

Husain

2023

Epilepsy Curr

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Section: Commentarymentioning

confidence: 99%

Section: Commentarymentioning

confidence: 99%

Section: Commentarymentioning

confidence: 99%

Section: Commentarymentioning

confidence: 99%

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“T” Times: Revisiting the Timing of Neuronal Injury in Status Epilepticus

Husain

2023

Epilepsy Curr

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“…Furthermore, early ASM treatment itself may positively influence the outcome. Detectable seizures and status epilepticus, but also subclinical epileptic activity on the electroencephalogram, may negatively impact outcome after stroke. Early ASMs effectively suppress seizures, thereby potentially reducing mortality.…”

mentioning

confidence: 99%

The SeLECT 2.0 Score—Significance of Treatment With Antiseizure Medication—Reply

Schubert,

Sinka,

Galovic

2023

JAMA Neurol

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Antiseizure Medication Use and Outcomes After Suspected or Confirmed Acute Symptomatic Seizures

Zafar,

Sivaraju,

Rubinos

et al. 2024

JAMA Neurol

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ImportanceAntiseizure medications (ASMs) are frequently prescribed for acute symptomatic seizures and epileptiform abnormalities (EAs; eg, periodic or rhythmic patterns). There are limited data on factors associated with ASM use and their association with outcomes.ObjectivesTo determine factors associated with ASM use in patients with confirmed or suspected acute symptomatic seizures undergoing continuous electroencephalography, and to explore the association of ASMs with outcomes.Design, Setting, and ParticipantsThis multicenter cohort study was performed between July 1 and September 30, 2021, at 5 US centers of the Post Acute Symptomatic Seizure Investigation and Outcomes Network. After screening 1717 patients, the study included 1172 hospitalized adults without epilepsy who underwent continuous electroencephalography after witnessed or suspected acute symptomatic seizures. Data analysis was performed from November 14, 2023, to February 2, 2024.ExposureASM treatment (inpatient ASM continuation ≥48 hours).Main Outcomes and MeasuresFactors associated with (1) ASM treatment, (2) discharge ASM prescription, and (3) discharge and 3-month Glasgow Outcome Scale score of 4 or 5 were ascertained.ResultsA total of 1172 patients (median [IQR] age, 64 [52-75] years; 528 [45%] female) were included. Among them, 285 (24%) had clinical acute symptomatic seizures, 107 (9%) had electrographic seizures, and 364 (31%) had EAs; 532 (45%) received ASM treatment. Among 922 patients alive at discharge, 288 (31%) were prescribed ASMs. The respective frequencies of inpatient ASM treatment and discharge prescription were 82% (233 of 285) and 69% (169 of 246) for patients with clinical acute symptomatic seizures, 96% (103 of 107) and 95% (61 of 64) for electrographic seizures, and 64% (233 of 364) and 48% (128 of 267) for EAs. On multivariable analysis, acute and progressive brain injuries were independently associated with increased odds of inpatient ASM treatment (odds ratio [OR], 3.86 [95% CI, 2.06-7.32] and 8.37 [95% CI, 3.48-20.80], respectively) and discharge prescription (OR, 2.26 [95% CI, 1.04-4.98] and 10.10 [95% CI, 3.94-27.00], respectively). Admission to the neurology or neurosurgery service (OR, 2.56 [95% CI, 1.08-6.18]) or to the neurological intensive care unit (OR, 7.98 [95% CI, 3.49-19.00]) was associated with increased odds of treatment. Acute symptomatic seizures and EAs were significantly associated with increased odds of ASM treatment (OR, 14.30 [95% CI, 8.52-24.90] and 2.30 [95% CI, 1.47-3.61], respectively) and discharge prescription (OR, 12.60 [95% CI, 7.37-22.00] and 1.72 [95% CI, 1.00-2.97], respectively). ASM treatment was not associated with outcomes at discharge (OR, 0.96 [95% CI, 0.61-1.52]) or at 3 months after initial presentation (OR, 1.26 [95% CI, 0.78-2.04]). Among 623 patients alive and with complete data at 3 months after discharge, 30 (5%) had postdischarge seizures, 187 (30%) were receiving ASMs, and 202 (32%) had all-cause readmissions.Conclusions and RelevanceThis study suggests that etiology and electrographic findings are associated with ASM treatment for acute symptomatic seizures and EAs; ASM treatment was not associated with functional outcomes. Comparative effectiveness studies are indicated to identify which patients may benefit from ASMs and to determine the optimal treatment duration.

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Effects of epileptiform activity on discharge outcome in critically ill patients in the USA: a retrospective cross-sectional study

Cited by 10 publications

References 25 publications

“T” Times: Revisiting the Timing of Neuronal Injury in Status Epilepticus

“T” Times: Revisiting the Timing of Neuronal Injury in Status Epilepticus

The SeLECT 2.0 Score—Significance of Treatment With Antiseizure Medication—Reply

Antiseizure Medication Use and Outcomes After Suspected or Confirmed Acute Symptomatic Seizures

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