Quantitative EEG-Based Seizure Estimation in Super-Refractory Status Epilepticus

Alkhachroum, Ayham; Ganesan, Saptharishi Lalgudi; Koren, Johannes; Kromm, Julie; Massad, Nina; Reyes, Renz; Miller, Michael R.; Roh, David; Agarwal, Sachin; Park, Soo‐Jin; Claassen, Jan

doi:10.1007/s12028-021-01395-x

Cited by 9 publications

(4 citation statements)

References 44 publications

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“…Of these, 309 were included for full-text evaluation, leading to the final inclusion of 95 studies (60 case reports, 2 interventional studies, and 33 case-control/cohort studies; for references see eTable 1 and 2 in Supplement 1 and a list of excluded studies is given in eTable 3 in Supplement 1), and 30 conference abstracts (n = 1200 reported patients). The study team identified 26 studies describing cohorts with 10 or more patients (data set 1, n = 1031 patients; Figure 1) and 104 studies describing individual patient data in sufficient detail (data set 2, n = 266 patients; Figure 1). The data sets partly overlapped and 97 patients were included in both.…”

Section: Resultsmentioning

confidence: 99%

Outcomes and Treatment Approaches for Super-Refractory Status Epilepticus

et al. 2023

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ImportanceSuper-refractory status epilepticus (SRSE) is defined as status epilepticus (SE) that continues or recurs 24 hours or more after the onset of anesthetic therapy or recurs on the reduction/withdrawal of anesthesia. Current clinical knowledge of the disease and optimal treatment approach is sparse.ObjectiveTo systematically assess clinical characteristics, causes, outcomes, prognostic factors, and treatment approaches for patients with SRSE.Design, Setting, and ParticipantsIn this systematic review and meta-analysis, all studies reporting adult patients (18 years or older) diagnosed with nonanoxic SRSE were considered for inclusion, irrespective of study design. The databases used were MEDLINE, Cochrane Library, EMBASE, and ClinicalTrials.org (database inception through May 5, 2022).Data extraction and synthesisThe study complied with the PRISMA guidelines for reporting, data extraction, and data synthesis. Different tools were used to assess risk of bias. All available data were extracted and missing data were neither imputed nor completed by contacting the study authors.Main outcome and measuresSuccessful treatment of SRSE, in-hospital mortality, and disability at discharge (estimated modified Rankin Scale).ResultsThe study team identified a total of 95 articles and 30 conference abstracts reporting 1200 patients with nonanoxic SRSE (266 individual patients were available for meta-analysis). They had a mean SRSE duration of 36.3 days, mean age of 40.8 years, and equal sex distribution. Patients with SRSE had a distinct pattern of etiologies where acute cerebral events and unknown etiologies accounted for 41.6% and 22.3% of all etiologies, respectively. Reports of SRSE caused by, eg, alcohol, drugs, or tumors were rare. At discharge, only 26.8% had none to slight disability (none, 16 [8.4%]; nonsignificant and slight disability, 35 [18.4%]). In-hospital mortality was 24.1%. Mortality stabilized after long-term treatment (more than 28 days) but with increased rates of seizure cessation and moderate to severe disability. Established prognostic factors, such as age and etiology, were not associated with in-hospital mortality. Reported treatment with ketamine, phenobarbital, other barbiturates, vagus nerve stimulator, and ketogenic diet were not associated with outcome.Conclusion and RelevancePatients with SRSE are distinct due to their pattern of care (eg, long-term treatment to younger patients without negative prognostic factors and unknown/nonmalignant etiologies) and their natural course of SE. Very long-term treatment was associated with lower mortality and high odds of cessation of SRSE but increased risk of moderate to severe disability.

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Section: Resultsmentioning

confidence: 99%

Outcomes and Treatment Approaches for Super-Refractory Status Epilepticus

et al. 2023

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“…Concurrent subtle clinical accompaniments iii. Spatiotemporal evolution day, and fair agreement (k = 0.4) between both qEEG novices (45).…”

Section: Quantitative Eeg (Qeeg) In the Icumentioning

confidence: 86%

Adult Critical Care Electroencephalography Monitoring for Seizures: A Narrative Review

2022

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Electroencephalography (EEG) is an important and relatively inexpensive tool that allows intensivists to monitor cerebral activity of critically ill patients in real time. Seizure detection in patients with and without acute brain injury is the primary reason to obtain an EEG in the Intensive Care Unit (ICU). In response to the increased demand of EEG, advances in quantitative EEG (qEEG) created an approach to review large amounts of data instantly. Finally, rapid response EEG is now available to reduce the time to detect electrographic seizures in limited-resource settings. This review article provides a concise overview of the technical aspects of EEG monitoring for seizures, clinical indications for EEG, the various available modalities of EEG, common and challenging EEG patterns, and barriers to EEG monitoring in the ICU.

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“…These tools allow ICU physicians to detect ESz with a high sensitivity but a low specificity. This emphasizes the need of an additional visual review of raw-EEG to exclude "falsepositive seizures" and avoid overtreatment [90,91]. Future promising automated tools are expected notably using artificial intelligence.…”

Section: Electroencephalogram Surveymentioning

confidence: 99%

Status epilepticus: what's new for the intensivist

Benghanem,

Pruvost-Robieux,

Neligan

et al. 2024

Current Opinion in Critical Care

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Purpose of review Status epilepticus (SE) is a common neurologic emergency affecting about 36.1/100 000 person-years that frequently requires intensive care unit (ICU) admission. There have been advances in our understanding of epidemiology, pathophysiology, and EEG monitoring of SE, and there have been large-scale treatment trials, discussed in this review. Recent findings Recent changes in the definitions of SE have helped guide management protocols and we have much better predictors of outcome. Observational studies have confirmed the efficacy of benzodiazepines and large treatment trials indicate that all routinely used second line treatments (i.e., levetiracetam, valproate and fosphenytoin) are equally effective. Better understanding of the pathophysiology has indicated that nonanti-seizure medications aimed at underlying pathological processes should perhaps be considered in the treatment of SE; already immunosuppressant treatments are being more widely used in particular for new onset refractory status epilepticus (NORSE) and Febrile infection-related epilepsy syndrome (FIRES) that sometimes revealed autoimmune or paraneoplastic encephalitis. Growing evidence for ICU EEG monitoring and major advances in automated analysis of the EEG could help intensivist to assess the control of electrographic seizures. Summary Research into the morbi-mortality of SE has highlighted the potential devastating effects of this condition, emphasizing the need for rapid and aggressive treatment, with particular attention to cardiorespiratory and neurological complications. Although we now have a good evidence-base for the initial status epilepticus management, the best treatments for the later stages are still unclear and clinical trials of potentially disease-modifying therapies are long overdue.

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Quantitative EEG-Based Seizure Estimation in Super-Refractory Status Epilepticus

Cited by 9 publications

References 44 publications

Outcomes and Treatment Approaches for Super-Refractory Status Epilepticus

Outcomes and Treatment Approaches for Super-Refractory Status Epilepticus

Adult Critical Care Electroencephalography Monitoring for Seizures: A Narrative Review

Status epilepticus: what's new for the intensivist

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