Prevalence and clinical correlates of non-convulsive status epilepticus in elderly patients with acute confusional state: A systematic literature review

Manfredonia, Francesco; Saturno, E.; Lawley, Andrew; Gasverde, Sabrina; Cavanna, Andrea E.

doi:10.1016/j.jns.2020.116674

Cited by 11 publications

(7 citation statements)

References 65 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Beim nonkonvulsiven SE ist es sehr wichtig, überhaupt einen klinischen Verdacht zu haben. Häufig finden sich neben der Bewusstseinsalteration geringe, leicht zu übersehende klinische Symptome wie myoklonische Entäußerungen der M. orbicularis oculi oder distaler Extremitätenmuskeln oder Verhaltensauffälligkeiten, die fluktuieren können [ 79 ]. Beim nonkonvulsiven SE ist das Vorliegen eines Komas ein ungünstiger Prädiktor für das klinische Outcome und sollte dokumentiert werden [ 131 ].…”

Section: Diagnostikunclassified

S2k-Leitlinie: Status Epilepticus im Erwachsenenalter

Rosenow

Weber

2021

Nervenarzt

View full text Add to dashboard Cite

ZusammenfassungDiese S2k-Leitlinie (LL) zum Status epilepticus (SE) im Erwachsenenalter schreibt die letzte DGN-LL zum SE von 2012 fort. Neue Definitionen und Evidenz wurden bei der Erstellung der LL und des Clinical Pathway berücksichtigt. Jeder epileptische Anfall, der länger als 5 Minuten anhält (oder ≥ 2 Anfälle über einen Zeitraum von mehr als 5 Minuten ohne Wiedererlangen des neurologischen Ausgangsstatus), soll als SE behandelt werden.In der Diagnostik sollte initial eine CCT oder, wenn möglich, eine MRT erfolgen. Das EEG spielt bei der Diagnosestellung und beim Therapiemonitoring von non-konvulsiven SE und zum Ausschluss bzw. Nachweis psychogener nichtepileptischer Anfälle eine wesentliche Rolle. Der prognostische Einfluss von insbesondere entzündlichen Begleiterkrankungen (z. B. Pneumonie) wurde besser belegt, weshalb entsprechende Laborparameter auch im Verlauf kontrolliert werden sollten und ggf. frühzeitig eine antibiotische Therapie initiiert werden sollte.Die Therapie erfolgt in 4 Stufen: 1. Initialer SE: Gabe eines ausreichend hoch dosierten Benzodiazepins i. m., i. v. oder i. n.; 2. Benzodiazepin-refraktärer SE: 1. Wahl ist die i.v. Gabe von Levetiracetam oder Valproat; 3. Refraktärer SE (RSE) und 4. Superrefraktärer SE (SRSE): I.v. Propofol oder Midazolam alleine oder in Kombination oder Thiopental in anästhetischen Dosen. Beim fokalen non-konvulsiven RSE kann unter Umständen auf die Einleitung eines therapeutischen Komas verzichtet werden. Bei SRSE sollte die ketogene Diät zum Einsatz kommen. I.v. Ketamin oder inhalatives Isofluran kann erwogen werden. In Einzelfällen kann die elektrokonvulsive Therapie und, bei resektabler epileptogener Zone, ein Epilepsie chirurgischer Eingriff erwogen werden. I.v. Allopregnanolon oder die Hyperthermie sollen nicht eingesetzt werden.

show abstract

Section: Diagnostikunclassified

S2k-Leitlinie: Status Epilepticus im Erwachsenenalter

Rosenow

Weber

2021

Nervenarzt

View full text Add to dashboard Cite

show abstract

“…The ictal delta or spike/sharp generalized pattern was the most common seen during the EEG recordings, followed by frontal focal involvement, similar to other studies. 21,25 In a recent clinical series that included 61 video-EEG recordings of 45 patients with NCSE, the main pattern consisted of recurrent discharges of rhythmic nonepileptiform delta/theta activity (62.3%), periodic discharges (39.4%), and spike-andwave or sharp-and-wave activity (23%). 25 Interestingly, the type of EEG pattern at the diagnosis is not related to the outcome 30 ; however, multiple status patterns in the EEGs with other clinical variables including etiology, refractory SE, and nonreactive EEGs have been reported associated with higher mortality.…”

Section: Discussionmentioning

confidence: 99%

Nonconvulsive Status Epilepticus: Clinical Findings, EEG Features, and Prognosis in a Developing Country, Mexico

San-Juan

Ángeles

González-Aragón

et al. 2022

Journal of Clinical Neurophysiology

View full text Add to dashboard Cite

There is a lack of clinical and epidemiological knowledge about nonconvulsive status epilepticus (NCSE) in developing countries including Mexico, which has the highest prevalence of epilepsy in the Americas. Our aim was to describe the clinical findings, EEG features, and outcomes of NCSE in a tertiary center in Mexico.Methods: We conducted a retrospective case series study (2010-2020) including patients ( $ 15 years old) with NCSE according to the modified Salzburg NCSE criteria 2015 with at least 6 months of follow-up. We extracted the clinical data (age, sex, history of epilepsy, antiseizure medications, clinical manifestations, triggers, and etiology), EEG patterns of NCSE, and outcome. Descriptive statistics and multinomial logistic regression were used.Results: One hundred thirty-four patients were analyzed; 74 (54.8%) women, the total mean age was 39.5 (15-85) years, and 71% had a history of epilepsy. Altered state of consciousness was found in 82% (including 27.7% in coma). A generalized NCSE pattern was the most common (32.1%). The NCSE etiology was mainly idiopathic (56%), and previous uncontrolled epilepsy was the trigger in 48% of patients. The clinical outcome was remission with clinical improvement in 54.5%. Multinomial logistic regression showed that the patient's age (P ¼ 0.04), absence of comorbidities (P ¼ 0.04), history of perinatal hypoxia (P ¼ 0.04), absence of clinical manifestations (P ¼ 0.01), and coma (P ¼ 0.03) were negatively correlated with the outcome and only the absence of generalized slowing in the EEG (P ¼ 0.001) had a significant positive effect on the prognosis.Conclusions: Age, history of perinatal hypoxia, coma, and focal ictal EEG pattern influence negatively the prognosis of NCSE.

show abstract

“…Several hypotheses can be made to explain this finding. First, NCSE, which is known to be more challenging to diagnose, is more common in the elderly 32 . Second, both ictal manifestations and interictal EEG findings are known to change with age, making the diagnosis of ictal features potentially more difficult among the older population 33 .…”

Section: Discussionmentioning

confidence: 99%

“…However, the identification of seizures and IEDs was not altered by age in the present study. Additionally, the differential diagnosis of seizures or SE in older patients is particularly wide, and IEDs have been reported in up to 30% of patients with nonepileptic events, often leading to the inappropriate prescription of antiseizure medication 26 , 32 , 33 .…”

Section: Discussionmentioning

confidence: 99%

Prospective evaluation of interrater agreement between EEG technologists and neurophysiologists

Beuchat

Alloussi

Reif

et al. 2021

Sci Rep

View full text Add to dashboard Cite

We aim to prospectively investigate, in a large and heterogeneous population, the electroencephalogram (EEG)-reading performances of EEG technologists. A total of 8 EEG technologists and 5 certified neurophysiologists independently analyzed 20-min EEG recordings. Interrater agreement (IRA) for predefined EEG pattern identification between EEG technologists and neurophysiologits was assessed using percentage of agreement (PA) and Gwet-AC1. Among 1528 EEG recordings, the PA [95% confidence interval] and interrater agreement (IRA, AC1) values were as follows: status epilepticus (SE) and seizures, 97% [96–98%], AC1 kappa = 0.97; interictal epileptiform discharges, 78% [76–80%], AC1 = 0.63; and conclusion dichotomized as “normal” versus “pathological”, 83.6% [82–86%], AC1 = 0.71. EEG technologists identified SE and seizures with 99% [98–99%] negative predictive value, whereas the positive predictive values (PPVs) were 48% [34–62%] and 35% [20–53%], respectively. The PPV for normal EEGs was 72% [68–76%]. SE and seizure detection were impaired in poorly cooperating patients (SE and seizures; p < 0.001), intubated and older patients (SE; p < 0.001), and confirmed epilepsy patients (seizures; p = 0.004). EEG technologists identified ictal features with few false negatives but high false positives, and identified normal EEGs with good PPV. The absence of ictal features reported by EEG technologists can be reassuring; however, EEG traces should be reviewed by neurophysiologists before taking action.

show abstract

Prevalence and clinical correlates of non-convulsive status epilepticus in elderly patients with acute confusional state: A systematic literature review

Cited by 11 publications

References 65 publications

S2k-Leitlinie: Status Epilepticus im Erwachsenenalter

S2k-Leitlinie: Status Epilepticus im Erwachsenenalter

Nonconvulsive Status Epilepticus: Clinical Findings, EEG Features, and Prognosis in a Developing Country, Mexico

Prospective evaluation of interrater agreement between EEG technologists and neurophysiologists

Contact Info

Product

Resources

About