Nonconvulsive status epilepticus after surgery for ruptured intracranial aneurysms: Incidence, associated factors, and impact on the outcome

Kikuta, Yoshichika; Kubota, Yuichi; Nakamoto, Hidetoshi; Chernov, Mikhail; Kawamata, Takakazu

doi:10.1016/j.clineuro.2020.106298

Cited by 9 publications

(11 citation statements)

References 41 publications

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“…Shneker et al observed that NCSE in patients correlated with substantial mortality (18%) and morbidity (39%) as early as 2003 (33). Patients diagnosed with this condition have longer hospital stays and experience more comorbid illnesses (10,34). Similarly, Kikuta et al showed that compared to the subgroup without NCSE, the risk of unfavorable outcomes at 3-months was nearly five-fold higher in patients with aneurysmal subarachnoid hemorrhage (34).…”

Section: Discussionmentioning

confidence: 99%

“…Patients diagnosed with this condition have longer hospital stays and experience more comorbid illnesses (10,34). Similarly, Kikuta et al showed that compared to the subgroup without NCSE, the risk of unfavorable outcomes at 3-months was nearly five-fold higher in patients with aneurysmal subarachnoid hemorrhage (34). The existing evidence in critically-ill patients suggests that NCSE may contribute to secondary brain injury or perpetual nerve damage.…”

Section: Discussionmentioning

confidence: 99%

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Associated Factors and Prognostic Implications of Non-convulsive Status Epilepticus in Ischemic Stroke Patients With Impaired Consciousness

et al. 2022

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Background and Purpose: Non-convulsive status epilepticus (NCSE) is common in patients with disorders of consciousness and can cause secondary brain injury. Our study aimed to explore the determinants and prognostic significance of NCSE in stroke patients with impaired consciousness.Method: Consecutive ischemic stroke patients with impaired consciousness who were admitted to a neuro intensive care unit were enrolled for this study. Univariate and multivariable logistic regression were used to identify factors associated with NCSE and their correlation with prognosis.Results: Among the 80 patients studied, 20 (25%) died during hospitalization, and 51 (63.75%) had unfavorable outcomes at the 3-month follow-up. A total of 31 patients (38.75%) developed NCSE during 24-h electroencephalogram (EEG) monitoring. Logistic regression revealed that NCSE was significantly associated with an increased risk of death during hospital stay and adverse outcomes at the 3-month follow-up. Patients with stroke involving the cerebral cortex or those who had a severely depressed level of consciousness were more prone to epileptogenesis after stroke.Conclusion: Our results suggest that NCSE is a common complication of ischemic stroke, and is associated with both in-hospital mortality and dependency at the 3-month follow-up. Long-term video EEG monitoring of stroke patients is, therefore required, especially for those with severe consciousness disorders (stupor or coma) or cortical injury.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Associated Factors and Prognostic Implications of Non-convulsive Status Epilepticus in Ischemic Stroke Patients With Impaired Consciousness

et al. 2022

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“…Late seizures (and thus diagnosis of epilepsy) occur in around 1–30% of patients [ 9 , 13 , 14 ] (depending on the length of follow-up). NCSE occurs in 3–15% [ 15 , 16 ] of patients with aSAH. Unlike self-limiting seizures, its presence has generally been found to be detrimental, with unfavorable outcome in up to 92% of patients [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of Seizures and Status Epilepticus on Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage

et al. 2022

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Background We aimed to evaluate the association between seizures as divided by timing and type (seizures or status epilepticus) and outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods All consecutive patients with aSAH admitted to the neurocritical care unit of the University Hospital Zurich between 2016 and 2020 were included. Seizure type and frequency were extracted from electronic patient files. Results Out of 245 patients, 76 experienced acute symptomatic seizures, with 39 experiencing seizures at onset, 18 experiencing acute seizures, and 19 experiencing acute nonconvulsive status epilepticus (NCSE). Multivariate analysis revealed that acute symptomatic NCSE was an independent predictor of unfavorable outcome (odds ratio 14.20, 95% confidence interval 1.74–116.17, p = 0.013) after correction for age, Hunt-Hess grade, Fisher grade, and delayed cerebral ischemia. Subgroup analysis showed a significant association of all seizures/NCSE with higher Fisher grade (p < 0.001 for acute symptomatic seizures/NCSE, p = 0.031 for remote symptomatic seizures). However, although acute seizures/NCSE (p = 0.750 and 0.060 for acute seizures/NCSE respectively) were not associated with unfavorable outcome in patients with a high Hunt-Hess grade, they were significantly associated with unfavorable outcome in patients with a low Hunt-Hess grade (p = 0.019 and p < 0.001 for acute seizures/NCSE, respectively). Conclusions Acute symptomatic NCSE independently predicts unfavorable outcome after aSAH. Seizures and NCSE are associated with unfavorable outcome, particularly in patients with a low Hunt-Hess grade. We propose that NCSE and the ictal or postictal reduction of Glasgow Coma Scale may hamper close clinical evaluation for signs of delayed cerebral ischemia, and thus possibly leading to delayed diagnosis and therapy thereof in patients with a low Hunt-Hess grade.

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“…Non-convulsive status epilepticus after craniocerebral surgery is common. 93 This guideline recommends that in case a patient has clinical manifestations of suspected non-convulsive status epilepticus (acute onset of mental and behavioral abnormalities, cognitive abnormalities, changes in the state of consciousness, language disorders, various sensory and autonomic abnormalities, etc. ), which cannot be fully explained by the lesions, the operation itself, or other known causes, the neurological function has not recovered after treatment of convulsive status epilepticus, or if the symptoms persist for more than 10 min, the possibility of non-convulsive status epilepticus should be considered, and video EEG monitoring (video EEG monitoring under conditions permission) should be put in place as soon as possible.…”

Section: Resultsmentioning

confidence: 99%

Chinese guideline on the application of anti-seizure medications in the perioperative period of supratentorial craniocerebral surgery

Liang

Fan

Chen

et al. 2022

Ther Adv Neurol Disord

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Seizures are a common symptom of craniocerebral diseases, and epilepsy is one of the comorbidities of craniocerebral diseases. However, how to rationally use anti-seizure medications (ASMs) in the perioperative period of craniocerebral surgery to control or avoid seizures and reduce their associated harm is a problem. The China Association Against Epilepsy (CAAE) united with the Trauma Group of the Chinese Neurosurgery Society, Glioma Professional Committee of the Chinese Anti-Cancer Association, Neuro-Oncology Branch of the Chinese Neuroscience Society, and Neurotraumatic Group of Chinese Trauma Society, and selected experts for consultancy regarding outcomes from evidence-based medicine in domestic and foreign literature. These experts referred to the existing research evidence, drug characteristics, Chinese FDA-approved indications, and expert experience, and finished the current guideline on the application of ASMs during the perioperative period of craniocerebral surgery, aiming to guide relevant clinical practice. This guideline consists of six sections: application scope of guideline, concepts of craniocerebral surgery-related seizures and epilepsy, postoperative application of ASMs in patients without seizures before surgery, application of ASMs in patients with seizures associated with lesions before surgery, emergency treatment of postoperative seizures, and 16 recommendations.

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Nonconvulsive status epilepticus after surgery for ruptured intracranial aneurysms: Incidence, associated factors, and impact on the outcome

Cited by 9 publications

References 41 publications

Associated Factors and Prognostic Implications of Non-convulsive Status Epilepticus in Ischemic Stroke Patients With Impaired Consciousness

Associated Factors and Prognostic Implications of Non-convulsive Status Epilepticus in Ischemic Stroke Patients With Impaired Consciousness

Impact of Seizures and Status Epilepticus on Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage

Chinese guideline on the application of anti-seizure medications in the perioperative period of supratentorial craniocerebral surgery

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