Seizures After Adult Cardiac Surgery and Interventional Cardiac Procedures

Pataraia, Ekaterina; Jung, Rebekka; Aull‐Watschinger, Susanne; Skhirtladze-Dworschak, Keso; Dworschak, Martin

doi:10.1053/j.jvca.2017.12.036

Cited by 13 publications

(12 citation statements)

References 56 publications

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“…Risk factors associated with seizures, most of which cannot or may only be partially altered. In other words, early diagnosis of seizures and identification of underlying causes is essential to reduce EEG seizure-associated long-term morbidity and mortality of patients ( 51 ).…”

Section: Discussionmentioning

confidence: 99%

Incidence, risk factors, and outcomes in electroencephalographic seizures after mechanical circulatory support: A systematic review and meta-analysis

Shen

Hong

et al. 2022

Front. Cardiovasc. Med.

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PurposeTo estimate the overall incidence, risk factors, and clinical outcomes of electroencephalographic (EEG) seizures for adults and children after mechanical circulatory support (MCS).Method and measurementsThis systematic review and meta-analysis were carried out in accordance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidance document. MEDLINE EMBASE and CENTRAL were investigated for relevant studies. The related information was retrieved by two independent reviewers and all analyses were conducted by STATA (version 16.0; Stata Corporation, College Station, TX, United States).ResultSixty studies including 36,191 adult and 55,475 pediatric patients with MCS were enrolled for evaluation. The study showed that the overall incidence of EEG seizures in adults was 2% (95%CI: 1–3%), in which 1% (95%CI: 1–2%) after cardiopulmonary bypass (CPB), and 3% (95%CI: 1–6%) after extracorporeal membrane oxygenation (ECMO). For pediatrics patients, the incidence of EEG seizures was 12% (95%CI: 11–14%), among which 12% (9–15%) after CPB and 13% (11–15%) after ECMO. The major risk factors of EEG seizures after MCS in adults were redo surgery (coefficient = 0.0436, p = 0.044), and COPD (coefficient = 0.0749, p = 0.069). In addition, the gestational week of CPB (coefficient = 0.0544, p = 0.080) and respiratory failure of ECMO (coefficient = –0.262, p = 0.019) were also indicated to be associated with EEG seizures in pediatrics.ConclusionEEG seizures after MCS were more common in pediatrics than in adults. In addition, the incidence of EEG seizure after ECMO was higher than CPB both in adults and children. It is expected that appropriate measures should be taken to control modifiable risk factors, thus improving the prognosis and increasing the long-term survival rate of MCS patients.Systematic Review Registration[https://www.crd.york.ac.uk/prospero], identifier [CRD42021287288].

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Section: Discussionmentioning

confidence: 99%

Incidence, risk factors, and outcomes in electroencephalographic seizures after mechanical circulatory support: A systematic review and meta-analysis

Shen

Hong

et al. 2022

Front. Cardiovasc. Med.

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“…The delay in seizure diagnosis past the 24 hours was studied to be associated with a 75% mortality rate due to prolonged nonconvulsive seizure activity. (15,19) While only two patients found to be classi ed as a nonconvulsive status epilepticus, it could be under-recognized considering the subtle presentation of the disease itself. Also, literatures have reported the range of the nonconvulsive status epilepticus to be 8-40% in critically ill patients (15,(19)(20)(21)(22), which implies the importance of the earlier suspicion of the possibility of the nonconvulsive seizure in patients who did not regain consciousness after the surgery for the purpose of the more favored prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…( 14) Though, its association with seizure has been reported; it crosses blood-brain-barrier easily and acts as a competitive antagonist at the glycine receptor due to its structural similarity with glycine, blocking its inhibitory action. (14,15) Image study results could be classi ed into four groups: acute stroke, PRES, seizure related changes, and previous cerebral lesions. There are multifactorial causes occurred during the surgery, which produce temporary or permanent lesions in the brain.…”

Section: Discussionmentioning

confidence: 99%

Seizure After Cardiopulmonary bypass Surgery: A Retrospective Study

Kim

Jang²,

Kim³

et al. 2021

Preprint

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Background: We are to investigate prognostic factors of seizure after cardiopulmonary bypass surgery based on the incidence, the operation parameters, and the outcomes of seizure.Methods: Consecutive patients presented a seizure after a cardiac or aortic surgery using a cardiopulmonary bypass (CPB) during the admission between January 2006 and January 2019 were retrospectively enrolled. Patients with a previous seizure history were excluded. The medical records were reviewed on the demographics, associated medical conditions, laboratory, electroencephalography (EEG), and imaging findings, cardiopulmonary bypass parameters, types of seizure, and prognosis.Results: Among the 488 patients who received cardiopulmonary surgery using CPB, 29 patients were diagnosed with seizure during admission. There were nine cases of aortic valve replacement, six of mitral valve replacement, four of aorta graft, two of patent ductus arteriosus closure, coronary artery bypass graft, tricuspid annuloplasty, and tumor resection for each. The average durations of the operation and of cardiopulmonary bypass were 278±119 and 108±55 minutes, respectively. The average aortic cross clamping time was 72±41 minutes. The median detection time of a seizure was 34.38±83.37 hours after surgery. Twenty-three patients (79.3%) did not show recovery of mental status after surgery until the seizure was detected. Seventeen patients were diagnosed with status epilepticus, and two of them had nonconvulsive status epilepticus. Nine showed repetitive seizures and three presented a single seizure. EEG analysis showed five cases of spike-and-wave, four of periodic discharges, four of rhythmic delta, and one of burst suppression. From the image studies, sixteen patients showed stroke, two revealed posterior reversible encephalopathy syndrome, and two showed seizure related changes. Nine (31.0%) expired in 25±27 postoperative day. For the survived patients, the average duration of ICU admission was 9±7 days.Conclusions: Due to its difficulty of detecting preclinical seizure after the surgery, evaluation including performance of EEG in early postoperative phase should be considered.

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“…Clinically evident seizures occur rarely (1–4% of patients) after cardiac surgery, mostly in the form of peri-operative generalized tonic–clonic seizures [ 5 ]. However, it should be kept in mind that other types of seizures have been observed after cardiac surgery and that a great proportion of seizures in critically ill patients is nonconvulsive [ 6 ]. These seizures are frequently missed or mistaken for different clinical events, leading to the suspicion that their true incidence is probably under-reported [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, it should be kept in mind that other types of seizures have been observed after cardiac surgery and that a great proportion of seizures in critically ill patients is nonconvulsive [ 6 ]. These seizures are frequently missed or mistaken for different clinical events, leading to the suspicion that their true incidence is probably under-reported [ 6 ]. Depending on the type and duration of seizures, they can have long-term consequences, including alteration of neuronal networks, neuronal injury up to neuronal death [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Epilepsy in patients undergoing cardiac surgery with ExtraCorporeal Circulation: case series and description of a peculiar clinical phenotype

et al. 2022

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Background Extracorporeal circulation (ECC) is now being increasingly used in critical care settings. Epileptic seizures are a recognized but under reported complication in patients receiving this care. Acute symptomatic post-operative seizures have been described, as well as remote seizure, mostly in the form of convulsive seizures. Epilepsy has also been reported, although with lower frequency and mainly with convulsive seizures, while different seizure semiology is rarely described. Case presentation We report a case series of four patients developing epilepsy with homogeneous features following heart surgery with ECC. We present neurophysiological and neuroradiological data and we describe the peculiar characteristics of epilepsies in terms of seizure semiology, frequency, and drug response. The main features are: an insulo-temporal or parieto-occipital semiology, often multifocal and without loss of consciousness or motor manifestations, a high frequency of seizures but with low impact on daily life, and a good response to anti-epileptic therapy. Conclusions We hypothesize a pathogenetic mechanism and we discuss the clinical implications of identifying these forms of epilepsy which tend to be often under-recognized.

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Seizures After Adult Cardiac Surgery and Interventional Cardiac Procedures

Cited by 13 publications

References 56 publications

Incidence, risk factors, and outcomes in electroencephalographic seizures after mechanical circulatory support: A systematic review and meta-analysis

Incidence, risk factors, and outcomes in electroencephalographic seizures after mechanical circulatory support: A systematic review and meta-analysis

Seizure After Cardiopulmonary bypass Surgery: A Retrospective Study

Epilepsy in patients undergoing cardiac surgery with ExtraCorporeal Circulation: case series and description of a peculiar clinical phenotype

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