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Abstract Details

Nonconvulsive Seizures and Status with CNS Neoplasms
Neuro-oncology
P07 - (-)
011
BACKGROUND: Clinical seizures are seen in 25% of patients with brain metastases and up to 75% of patients with primary brain tumors. Both groups are at risk for sudden changes in mental status which can be due to metabolic-infectious, structural causes or nonconvulsive seizures. The risk of NCS in patients with neoplastic brain tumors presenting with mental status changes is unknown.
DESIGN/METHODS: We present a retrospective review of patients admitted between 1/2010 and 4/2011 with central nervous system neoplasms and altered mental status who underwent continuous EEG monitoring (cEEG). Patients in the immediate post-operative period were excluded.
RESULTS: 54 patients who were identified for this investigation, 43 with primary CNS tumors and 11 with metastatic disease to the brain. 24 patients (44%) were found to have epileptiform discharges (sharp waves/spikes, periodic discharges, and rhythmic delta activity). 20 patients (37%) were found to have seizures, 11 of them purely subclinical (20%). Of these 11, only 4 had electrographic seizures in the initial 30 minute EEG and 7 were detected during subsequent longterm monitoring. Primary CNS tumors were associated with a higher incidence of seizures, 40% vs 27% in patients with metastasis.
CONCLUSIONS: NSCE ranging from 6-33% have been reported in patients with impaired mentation and acute brain lesions such as traumatic brain injury, subarachnoid hemorrhage, stroke and CNS infection. Our study shows a similar rate of NCS in tumor patients presenting with acute mental status change. The rate of detection of NCS on 30 minute EEG was only 36% and most seizures were only detected during longterm monitoring. Patients with brain tumors presenting with sudden altered mentation require longterm monitoring to evaluate for and treat nonconvulsive seizures which are seen in 20% of patients.
Authors/Disclosures
Jeffrey D. Kennedy, MD (University of California, Davis)
PRESENTER 		Dr. Kennedy has nothing to disclose.
Indranil Sen-Gupta, MD Dr. Sen-Gupta has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Guidepoint Global Advisors.
Wendy Sherman, MD (Mayo Clinic) Dr. Sherman has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Focused ultrasound foundation . Dr. Sherman has received personal compensation in the range of $500-$4,999 for serving as a Advisory Board Member with Kiyatec.
Priya U. Kumthekar, MD Dr. Kumthekar has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biocept. Dr. Kumthekar has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Enclear. Dr. Kumthekar has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Affinia Therapeutics. Dr. Kumthekar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. Dr. Kumthekar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Orbus Therapeutics. Dr. Kumthekar has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bioclinica. Dr. Kumthekar has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novocure. Dr. Kumthekar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Kumthekar has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Bioclinica. Dr. Kumthekar has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Servier. Dr. Kumthekar has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for BPGbio. Dr. Kumthekar has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Seagen.
Warren P. Mason, MD, FAAN (Princess Margaret cancer Centre) Dr. Mason has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novocure. Dr. Mason has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Mason has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Servier. Dr. Mason has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Boeringher Ingelheim. Dr. Mason has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Ono Therapeutics.
Michael P. Macken, MD, MRCPI (Northwestern Medical Faculty Foundation) Dr. Macken has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Jazz Pharma. Dr. Macken has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for UCB. Dr. Macken has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for SK LifeSciences. Dr. Macken has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for LivaNova. The institution of Dr. Macken has received research support from LivaNova.
Elizabeth Gerard, MD (Northwestern University) Dr. Gerard has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Xenon. The institution of Dr. Gerard has received research support from NIH/NINDS. The institution of Dr. Gerard has received research support from Xenon Pharmaceuticals. The institution of an immediate family member of Dr. Gerard has received research support from NIH. The institution of Dr. Gerard has received research support from Eisai, Inc. (via Stanford University). Dr. Gerard has received publishing royalties from a publication relating to health care.
Jeffrey J. Raizer, MD No disclosure on file
Stephan Schuele, MD, FAAN (Northwestern Memorial Hospital) Dr. Schuele has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Monteris. Dr. Schuele has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Neurelis. Dr. Schuele has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for SK Life Science. Dr. Schuele has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Jazz. Dr. Schuele has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Clinical Neurophysiology. Dr. Schuele has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Thomas Needham. Dr. Schuele has received research support from National Institute of Health.