Nonconvulsive Status Epilepticus following Generalized Tonic-Clonic Seizures

Bauer, Gerhard; Aichner, F.; Mayr, U.

doi:10.1159/000115515

Cited by 38 publications

(24 citation statements)

References 14 publications

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“…Cases of generalized NCSE with focal predominance, similar to our group G F cases, have been reported in the literature (Niedermeyer et al, 1979). Other investigators (Roger et al, 1974;Bauer et al, 1982;Tomson et al, 1986Tomson et al, , 1992Fagan and Lee, 1990) have also speculated on the existence of secondarily generalized NCSE.…”

Section: Discussionsupporting

confidence: 85%

Nonconvulsive Status Epilepticus: EEG Analysis in a Large Series

1994

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We analyzed EEG characteristics comprehensively in a large series of nonconvulsive status epilepticus (NCSE) cases. Eighty-five ictal episodes in 78 patients were analyzed. The ictal discharges were generalized (group G) in 59 episodes (69%), diffuse with focal predominance (group GF) in 15 (18%), and focal (group F) in 11 (13%). The morphologies and patterns of persistence varied greatly. Frequency of ictal discharge was also variable and was almost always < 3 Hz. Demonstration of focal epileptic features in response to intravenous (i.v.) diazepam (DZP) and the presence of interictal focal epileptiform discharges in some cases in groups G and GF suggested possible focal onset secondarily generalized in these cases. This study suggests that electrographically NCSE is a highly heterogeneous epileptic state, and i.v. DZP may serve as a valuable diagnostic tool in differentiating generalized from focal onset NCSE.

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Section: Discussionsupporting

confidence: 85%

Nonconvulsive Status Epilepticus: EEG Analysis in a Large Series

1994

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“…It is well recognized that there are often epileptic causes of coma: generalized tonic-clonic seizures are followed by a short and transient phase of postictal coma [11]. More prolonged phases of a decreased level of consciousness are found with various types of nonconvulsive SE (NCSE) [12,13], such as complex focal SE (or SE with impaired consciousness), but they rarely reach deeper stages of coma, especially in patients with a previous epilepsy diagnosis. In case of prolonged refractory and super-refractory SE, the patient is deeply comatose as a rule, with only minor motor phenomena, or even complete absence of clinical signs of SE.…”

Section: Introductionmentioning

confidence: 99%

Which EEG patterns in coma are nonconvulsive status epilepticus?

Trinka¹,

Leitinger²

2015

Epilepsy & Behavior

137

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Nonconvulsive status epilepticus (NCSE) is common in patients with coma with a prevalence between 5% and 48%. Patients in deep coma may exhibit epileptiform EEG patterns, such as generalized periodic spikes, and there is an ongoing debate about the relationship of these patterns and NCSE. The purposes of this review are (i) to discuss the various EEG patterns found in coma, its fluctuations, and transitions and (ii) to propose modified criteria for NCSE in coma. Classical coma patterns such as diffuse polymorphic delta activity, spindle coma, alpha/theta coma, low output voltage, or burst suppression do not reflect NCSE. Any ictal patterns with a typical spatiotemporal evolution or epileptiform discharges faster than 2.5 Hz in a comatose patient reflect nonconvulsive seizures or NCSE and should be treated. Generalized periodic diacharges or lateralized periodic discharges (GPDs/LPDs) with a frequency of less than 2.5 Hz or rhythmic discharges (RDs) faster than 0.5 Hz are the borderland of NCSE in coma. In these cases, at least one of the additional criteria is needed to diagnose NCSE (a) subtle clinical ictal phenomena, (b) typical spatiotemporal evolution, or (c) response to antiepileptic drug treatment. There is currently no consensus about how long these patterns must be present to qualify for NCSE, and the distinction from nonconvulsive seizures in patients with critical illness or in comatose patients seems arbitrary. The Salzburg Consensus Criteria for NCSE [1] have been modified according to the Standardized Terminology of the American Clinical Neurophysiology Society [2] and validated in three different cohorts, with a sensitivity of 97.2%, a specificity of 95.9%, and a diagnostic accuracy of 96.3% in patients with clinical signs of NCSE. Their diagnostic utility in different cohorts with patients in deep coma has to be studied in the future. This article is part of a Special Issue entitled "Status Epilepticus".

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“…In most of the patients coma was the only clinical manifestation. The mortality rate was also more than two fold higher among those patients identified with NCSE compared to those who recovered with cessation of convulsion 32 . Therefore, cEEG monitoring should be performed on any patient who does not quickly regain consciousness after a convulsive seizure to detect ongoing seizure activity.…”

Section: Ncszs Following Convulsive Status Epilepticus (Se)mentioning

confidence: 94%

“…Presence of continuous electrographic seizures has been identified in many cases after control of convulsive SE 21,27,28,29,32,33,61 . In most of the patients coma was the only clinical manifestation.…”

Section: Ncszs Following Convulsive Status Epilepticus (Se)mentioning

confidence: 99%

EEG in ICU: A monitoring tool for critically ill patient

Banu

2014

Bangladesh Crit Care J

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Electroencephalographic monitoring provides dynamic information about the brain function that permits early detection of changes in neurologic status, which is especially useful when the clinical examination is limited. Identification of ongoing electrographic seizures, non-convulsive status epilepticus (NCSE), periodic epileptogenic discharges (PED), irreversible cerebral dysfunction i.e., isoelectric tracing would help the care providers in appropriate decision making regarding the management. Non-convulsive seizures (NCSz) are more common than previously recognized and are associated with worse outcome if not treated in time. Majority of seizures at the ICU are not clinically identified because of the disease phenomena or as the patient may remain under sedation. Studies revealed the first NCSz within 1 to 24 hours of EEG monitoring; longer period of monitoring is required in comatose patient and those with PED. Factors associated with an increased risk of NCSz and NCSE include coma, prior clinical seizures, CNS infection, trauma, stroke, hypoxic ischemic encephalopathy, brain tumor, recent neurosurgery, and PED.In resource-poor situation, EEG is frequently requested to confirm brain death, particularly where there is limited information on neurological examination or inconclusive apnea test; or when the patient is in prolonged state of coma. Presence of isoelectric tracing for at least 30 minutes in the EEG along with other clinical evidences is helpful in such situations. Extreme care should be taken for recording and reviewing continuous EEG (cEEG) monitoring at the ICU where sources of electrical noise are present. Patients identified with electrographic seizures and mild to moderate degree encephalopathy, with presence of normal background activities had better outcome compared to those with PED, monorrhythmic alpha beta coma and severe generalized encephalopathy. Real-time detection of ischemia at a reversible state is technologically feasible with cEEG and should be developed into a practical form for prevention of in-hospital infarction. Brain function monitoring with EEG is useful and this is in great demand at the ICU of present time. Such monitoring can help to improve neurological outcome in a variety of ICU settings. DOI: http://dx.doi.org/10.3329/bccj.v2i1.19954 Bangladesh Crit Care J March 2014; 2 (1): 28-34

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Nonconvulsive Status Epilepticus following Generalized Tonic-Clonic Seizures

Cited by 38 publications

References 14 publications

Nonconvulsive Status Epilepticus: EEG Analysis in a Large Series

Nonconvulsive Status Epilepticus: EEG Analysis in a Large Series

Which EEG patterns in coma are nonconvulsive status epilepticus?

EEG in ICU: A monitoring tool for critically ill patient

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