Nonconvulsive Status Epilepticus During Perioperative Period of Cerebrovascular Surgery

Abstract

Nonconvulsive status epilepticus (NCSE) is generally defined as a change in behavior and/or mental process from the baseline, which is associated with ongoing seizure activity or continuous epileptiform discharges on electroencephalography (EEG) in the absence of convulsive seizures. The present study investigated NCSE incidence using serial EEG during the perioperative periods of cerebrovascular surgery at a medium-sized, local hospital. A total of 54 patients were admitted to our department and underwent various neurosurgical procedures over a course of one year. If clinical symptoms worsened without clear explanation, EEG was performed, resulting in a diagnosis of NCSE in four patients (7.4%). The EEG abnormalities included periodic lateralized epileptiform discharges in 1 patient, triphasic waves in 2 patients, and repeated ictal discharges in 1 patient. Improved mental status and consciousness level, together with disappearance of EEG abnormalities, after appropriate anticonvulsant treatment supported the diagnosis of NCSE. The present study stressed the importance of EEG if no adequate explanation for neurological deterioration can be determined from the clinical course, laboratory data, or neuroimaging examination.

Nonconvulsive Partial Status Epilepticus Mimicking Recurrent Infarction Revealed by Diffusion-weighted and Arterial Spin Labeling Perfusion Magnetic Resonance Images

“…In most hospital, routine EEG examination is unavailable outside working hours or on weekends, and the timing of EEG recording is often delayed. 16,17 In the present study, we could not obtained ictal discharges in all 4 episodes of our 2 cases. A further problem in the EEG diagnosis of epilepsy is the sensitivity of post-or interictal EEG.…”

“…Nonconvulsive partial SE can be complicated with stroke both in the acute and chronic stages. 12,16,17 In the present cases, cortical hyperintensity on DW-MRI was transient and subsequent T2 prolonged lesion was not demonstrated on the follow-up images. Therefore, the recurrence of cerebral infarction can be ruled out.…”

“…12,16,17 However, it is practically difficult to record the ictal discharges without continuous EEG monitoring facilities. In most hospital, routine EEG examination is unavailable outside working hours or on weekends, and the timing of EEG recording is often delayed.…”

Electroencephalographic Evaluation of Cerebral Hyperperfusion Syndrome Following Superficial Temporal Artery-Middle Cerebral Artery Anastomosis

“…13,23,25,31) Only EEG examinations of 10 patients with CHS for several days after CEA revealed periodic lateralizing epileptiform discharges on the operated hemisphere, even in the absence of seizures or during the postictal state. 28) Since periodic lateralizing epileptiform discharges are one of the EEG patterns in patients with NCSE, 2,12,22) these cases probably had similar pathophysiological conditions to those of Case 3 in the development of CHS.…”

A Case of Nonconvulsive Status Epilepticus Presenting with Triphasic Waves

“…[3][4][5] Bunun yanı sıra trifazik dalgalar gü-nümüzde NKSE'nin EEG bulgularından biri sayılmakta olup sıklıkla metabolik ensefalopatiler ile ayırıcı tanıda güçlüğe neden olmaktadır. [6] EEG bulgularındaki benzerliğin yanı sıra hem NKSE hem de ensefalopati tablolarında bilinç ve mental aktivitede bozulma, davranış değişikliği ya da psikiyatrik semptomlar gibi benzer klinik belirtiler görülebilmektedir. [7] Bu iki durumun yönetimi birbirinden farklı olup NKSE'de antiepileptik ilaç-ların kullanımı gerekmekte, metabolik ensefalopatide ise altta yatan etyolojiye yönelik tedaviler uygulanmaktadır.…”