Nonconvulsive seizures: Developing a rational approach to the diagnosis and management in the critically ill population

Jirsch, Jeffrey; Hirsch, Lawrence J.

doi:10.1016/j.clinph.2006.11.312

Cited by 165 publications

(118 citation statements)

References 80 publications

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“…In additional, albeit indirect, support of our hypothesis, frontal white matter volume and amplitude of resting delta EEG oscillations (1.5-4 Hz) show negative correlation in patients with mild cognitive impairment and Alzheimer's disease (Fernandez et al, 2003;Babiloni et al, 2006). Little progress has been made in the debate about the nature of periodic discharge types and mechanisms (Chong and Hirsch, 2005;Hirsch et al, 2005;Jirsch and Hirsch, 2007). The variety of structural damages has hindered the development of a unifying theory about the pathophysiology (Yemisci et al, 2003;Gurer et al, 2004;Kalamangalam et al, 2007).…”

Section: Discussionmentioning

confidence: 85%

Pathological Effect of Homeostatic Synaptic Scaling on Network Dynamics in Diseases of the Cortex

Fröhlich¹,

Bazhenov²,

Sejnowski³

2008

J. Neurosci.

102

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Slow periodic EEG discharges are common in CNS disorders. The pathophysiology of this aberrant rhythmic activity is poorly understood. We used a computational model of a neocortical network with a dynamic homeostatic scaling rule to show that loss of input (partial deafferentation) can trigger network reorganization that results in pathological periodic discharges. The decrease in average firing rate in the network by deafferentation was compensated by homeostatic synaptic scaling of recurrent excitation among pyramidal cells. Synaptic scaling succeeded in recovering the network target firing rate for all degrees of deafferentation (fraction of deafferented cells), but there was a critical degree of deafferentation for pathological network reorganization. For deafferentation degrees below this value, homeostatic upregulation of recurrent excitation had minimal effect on the macroscopic network dynamics. For deafferentation above this threshold, however, a slow periodic oscillation appeared, patterns of activity were less sparse, and bursting occurred in individual neurons. Also, comparison of spike-triggered afferent and recurrent excitatory conductances revealed that information transmission was strongly impaired. These results suggest that homeostatic plasticity can lead to secondary functional impairment in case of cortical disorders associated with cell loss.

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Section: Discussionmentioning

confidence: 85%

Pathological Effect of Homeostatic Synaptic Scaling on Network Dynamics in Diseases of the Cortex

Fröhlich¹,

Bazhenov²,

Sejnowski³

2008

J. Neurosci.

102

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“…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].…”

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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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Devarajan

Siyam

Alexopoulos

et al. 2010

Can J Anesth/J Can Anesth

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Nonconvulsive seizures: Developing a rational approach to the diagnosis and management in the critically ill population

Cited by 165 publications

References 80 publications

Pathological Effect of Homeostatic Synaptic Scaling on Network Dynamics in Diseases of the Cortex

Pathological Effect of Homeostatic Synaptic Scaling on Network Dynamics in Diseases of the Cortex

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

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

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