Abstract Details

Title Non-Convulsive Seizures and Non-Convulsive Status Epilepticus in a Neurological Intensive Care Unit: Risk Factors and Outcomes

Topic Clinical Neurophysiology

Presentation(s) S39 - (-)

Poster/Presentation
Number 004

Objective

Background NCS has been reported in 8-19% of ICU patients with altered mental status (AMS). NCSE may cause permanent neuronal damage via increased extracellular glutamate, leading to brain swelling and apoptosis. Delayed diagnosis and treatment of NCS may increase mortality. Little data exists regarding factors influencing outcome in ICU patients with NCS/NCSE.

Design/Methods Our prospective observational study recruited adults in our neurological ICU with unexplained AMS, unrelated to anoxia or hypothermia, between January and July 2012. After brain imaging, patients were placed on continuous EEG (cEEG) as medically indicated. NCSE was defined as continuous or recurrent ictal discharges for 30 minutes. We analyzed EEG pattern, clinical signs, risk factors (e.g. acute cerebral lesion, preexisting epilepsy), treatment response, and outcome in patients with and without NCS/NCSE.

Results NCS/NCSE was detected in 20% of 139 patients(11 NCS, 17 NCSE). Factors associated with NCS/NCSE included history of epilepsy (p=0.039), seizure at presentation (p=0.001), intracranial tumor (p=0.007), and acute CNS infection (p=0.06). Subtle clinical signs such as twitching or eye deviation were found in 57% of the NCS/NCSE group (p=0.001). Mortality was higher in the NCS/NCSE group (29% vs12%, p=0.084). cEEG changed management of anticonvulsant in 39% of all cases. All six of the NCSE patients treated to burst-suppression with anesthetic infusions died.

Conclusions Subtle clinical findings, history of seizures, intracranial tumor, or acute CNS infection should raise suspicion for NCS/NCSE in ICU patients with AMS. However, cEEG remains essential in diagnosis and management. Mortality is high in NCSE; further study may help to understand the relationship between etiology, NCSE subtypes, treatment and outcome. A preliminary version of these data will be presented at the American Epilepsy Society meeting in December 2012.

Authors/Disclosures
Ikuko Laccheo, MD (Nuvasive Clinical Service/American Neuromonitoring Associates) PRESENTER	Dr. Laccheo has nothing to disclose.
Hasan Sonmezturk, MD (Vanderbilt University Medical Center)	No disclosure on file
Amar Bhatt, MD, FAAN (Rush University Medical Center)	No disclosure on file
Tracy T. Batchelor, MD, MPH (Brigham and Women's Hospital)	Dr. Batchelor has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Up To Date, Inc. An immediate family member of Dr. Batchelor has received publishing royalties from a publication relating to health care. Dr. Batchelor has received publishing royalties from a publication relating to health care.
	No disclosure on file
	No disclosure on file
	No disclosure on file
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	No disclosure on file
Bassel W. Abou-Khalil, MD, FAAN (Vanderbilt University)	The institution of Dr. Abou-Khalil has received research support from Cerevel. The institution of Dr. Abou-Khalil has received research support from Xenon. The institution of Dr. Abou-Khalil has received research support from Otsuka. The institution of Dr. Abou-Khalil has received research support from UCB. The institution of Dr. Abou-Khalil has received research support from SK LIfe Science. The institution of Dr. Abou-Khalil has received research support from Neuroelectrics.
Kevin F. Haas, MD, PhD (Vanderbilt University Medical Center)	No disclosure on file

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