Salzburg consensus criteria are associated with long-term outcome after non-convulsive status epilepticus

Monsson, Olav; Roberg, Lars Egil; Gesche, Joanna; Beier, Christoph P.; Krøigård, Thomas

doi:10.1016/j.seizure.2022.05.006

Cited by 8 publications

(8 citation statements)

References 48 publications

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“…In a larger cohort of NCSE patients categorized on the presence/absence of Salzburg criterion A1, authors identified an association between criterion A1 and the 2‐year survival rate. However, no significant association was observed between criterion A1 and short‐term outcome, 27 as our results confirmed. Interestingly, the same study revealed a survival trend in the presence of an A2 pattern.…”

Section: Discussionsupporting

confidence: 70%

“…To the best of our knowledge, only few studies have investigated a possible association between specific Salzburg criteria and patients' outcome. [26][27][28] Singh et al 26 could not identify any correlation between the Salzburg criteria and outcome, within a cohort of patients with NCSE and nonconvulsive seizures who underwent ICU continuous EEG monitoring. However, the limited sample size, the reduced mortality, and the multiple EEG patterns detected during the monitoring limited the interpretation of their findings.…”

Section: Discussionmentioning

confidence: 95%

“…To the best of our knowledge, only few studies have investigated a possible association between specific Salzburg criteria and patients' outcome 26–28 . Singh et al.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic value of Salzburg nonconvulsive status epilepticus criteria: The SACE score

Misirocchi,

Zilioli,

Mannini

et al. 2023

Epilepsia

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ObjectiveTo investigate the association between NCSE Salzburg criteria and in‐hospital outcome, to determine the predictive accuracy of STESS, mSTESS, EMSE and END‐IT in NCSE patients and to develop a new prognostic score specifically designed for NCSE patients.MethodsClinical and EEG data of adult patients treated for NCSE from 2020 to 2023 were retrospectively assessed. Age, sex, mRS at admission, comorbidities, history of seizures, etiology, SE type and outcome were collected from the patients’ digital charts. EEG data were assessed and categorized applying the Salzburg NCSE Criteria. In‐hospital death was defined as the primary outcome.Results116 NCSE patients were included. Multivariable logistic regression revealed that the Salzburg NCSE criterion A2 (ictal morphological, spatial, and temporal evolution) was associated with in‐hospital survival. The best STESS cut‐off was ≥4 (sensitivity 0.62, specificity 0.69, accuracy 67%). mSTESS≥5 reached a sensitivity of 0.68, a specificity of 0.57, and an overall accuracy of 60%, EMSE≥64 a sensitivity of 0.82, a specificity of 0.39, and an overall accuracy of 52%, END‐IT≥3 a sensitivity of 0.65, a specificity of 0.44, and an overall accuracy of 50%.Through a hypothesis generating approach we developed the SACE score, which integrates EEG features (criterion A2) to patient age (with a 75‐years cutoff), history of seizure and level of consciousness. With a cutoff of ≥ 3, it had a sensitivity of 0.77, a specificity of 0.74, and an overall accuracy of 76%, performing better than other prognostic scores.SignificanceWe developed a new user‐friendly scoring system, the SACE score, which integrates EEG features to other established outcome‐related variables assessable in early stages, to assist neurologists and neurointensivists in making more tailored prognostic decisions for NCSE patients.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 95%

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Prognostic value of Salzburg nonconvulsive status epilepticus criteria: The SACE score

Misirocchi,

Zilioli,

Mannini

et al. 2023

Epilepsia

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“…The quantification of neurological deterioration after SE is difficult. We chose the established NIHSS in this and related studies 23,29 because it appeared to be the “least bad established score” available and covers mainly supratentorial functions 27 . We found a modified Rankin Scale and Barthel index, indicating that retrospective assessment of the neurological status using NIHSS provides meaningful results 23 .…”

Section: Discussionmentioning

confidence: 99%

“…All available EEGs were analyzed systematically according to the Salzburg criteria 25 by L.E.R., O.M., and T.K., who were blinded to clinical data apart from the SE diagnosis. Details of the analysis were published previously in Monsson et al 29 …”

Section: Methodsmentioning

confidence: 99%

Association of ictal imaging changes in status epilepticus and neurological deterioration

et al. 2022

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Objective In patients with status epilepticus (SE), the clinical significance of ictal changes on magnetic resonance imaging (MRI) is insufficiently understood. We here studied whether the presence of ictal MRI changes was associated with neurological deterioration at discharge. Methods The retrospective cohort comprised all identifiable patients treated at Odense University Hospital in the period 2008–2017. All amenable MRIs were systemically screened for ictal changes. Patient demographics, electroencephalography, seizure characteristics, treatment, and SE duration were assessed. Neurological status was estimated before and after SE. The predefined endpoint was the association of neurological deterioration and ictal MRI changes. Results Of 261 eligible patients, 101 received at least one MRI during SE or within 7 days after cessation; 43.6% (44/101) had SE due to non‐ or less brain‐damaging etiologies. Patients who received MRI had a longer duration of SE, less frequently had a history of epilepsy, and were more likely to have SE due to unknown causes. Basic characteristics (including electroencephalographic features defined by the Salzburg criteria) did not differ between patients with (n = 20) and without (n = 81) ictal MRI changes. Timing of MRI was important; postictal changes were rare within the first 24 h and hardly seen >5 days after cessation of SE. Ictal MRI changes were associated with a higher risk of neurological deterioration at discharge irrespective of etiology. Furthermore, they were associated with a longer duration of SE and higher long‐term mortality that reached statistical significance in patients with non‐ or less brain‐damaging etiologies. Significance In this retrospective cohort, ictal changes on MRI were associated with a higher risk of neurological deterioration at discharge and, possibly, with a longer duration of SE and poorer survival.

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Postictal Encephalopathy After Status Epilepticus: Outcome and Risk Factors

Bode,

Kristensen,

Olsen

et al. 2023

Neurocrit Care

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Background Postictal encephalopathy is well known after status epilepticus (SE), but its prognostic impact and triggers are unknown. Here, we aimed to establish risk factors for the development of postictal encephalopathy and to study its impact on survival after discharge. Methods This retrospective cohort study comprised adult patients diagnosed with first nonanoxic SE at Odense University Hospital between January 2008 and December 2017. Patients with ongoing SE at discharge or unknown treatment success were excluded. Postictal symptoms of encephalopathy were estimated retrospectively using the West Haven Criteria (WHC). WHC grade was determined for postictal day 1 to 14 or until the patient died or was discharged from the hospital. Cumulative postictal WHC during 14 days after SE-cessation was used to quantify postictal encephalopathy. Clinical characteristics, patient demographics, electroencephalographic and imaging features, and details on intensive care treatment were assessed from medical records. Results Of all eligible patients (n = 232), 198 (85.3%) had at least WHC grade 2 postictal encephalopathy that lasted for > 14 days in 24.5% of the surviving patients. WHC grade at discharge was strongly associated with poor long-term survival (p < 0.001). Postictal encephalopathy was not associated with nonconvulsive SE, postictal changes on magnetic resonance imaging, or distinct ictal patterns on electroencephalography. Although duration of SE and treatment in the intensive care unit showed an association with cumulative postictal WHC grade, they were not independently associated with the degree of encephalopathy when controlling for confounders. In a linear regression model, etiology, duration of sedation, age, and premorbid modified Rankin Scale were significant and consistent predictors for higher cumulative postictal WHC grade. Exploratory analyses showed an association of a cumulative midazolam dosage (mg/kg/h) with higher cumulative postictal WHC grade. Discussion In this cohort, postictal encephalopathy after SE was common and associated with poor long-term survival. Seizure characteristics were not independently associated with postictal encephalopathy; the underlying etiology, long (high-dose midazolam) sedation, high age, and poor premorbid condition were the major risk factors for its development.

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Salzburg consensus criteria are associated with long-term outcome after non-convulsive status epilepticus

Cited by 8 publications

References 48 publications

Prognostic value of Salzburg nonconvulsive status epilepticus criteria: The SACE score

Prognostic value of Salzburg nonconvulsive status epilepticus criteria: The SACE score

Association of ictal imaging changes in status epilepticus and neurological deterioration

Postictal Encephalopathy After Status Epilepticus: Outcome and Risk Factors

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