Abstract Details

Title Seizure Duration and Timepoint Cutoffs for Statistically Defining a Prolonged Seizure: A Post Hoc Analysis of the SCORE Video-EEG Database

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 10-009

Objective We explored statistically appropriate timepoint(s) for defining possible/probable prolonged seizures by seizure type.

Background Most seizures are brief and self-limiting, but some will cluster, grow prolonged and more severe. Defining prolonged seizures accurately informs when to ideally give acute medication to prevent status epilepticus (SE). Prolonged seizures have been defined as >2 minutes for generalized absence seizures and the convulsive phase of bilateral tonic-clonic seizures (focal/generalized onset), and >5 minutes for focal seizures.

Design/Methods Post hoc analysis of 2742 seizures from 887 video-electroencephalography (V-EEG) recordings of 725 patients (including outliers). Seizure duration was measured clinically/via EEG and analyzed using Tukey’s box plot. For each seizure type, outliers were categorized as possibly (>1.5×IQR above Q3) or probably (>3×IQR above Q3) prolonged. Patients with SE were excluded (n=20), which is a limitation.

Results Using Tukey’s method, 4% (97/2742) of seizures observed clinically and 6% (159/2742) of those observed via EEG were classified as either possibly/probably prolonged. Cutoffs (clinical/EEG duration, seconds) for possibly prolonged seizures: focal preserved consciousness 48.75/60.5; focal consciousness unknown 48.5/70.25; focal tonic 45.75/51.75; focal to bilateral tonic-clonic 167.75/189.5; focal clonic 48.5/56.5; focal impaired consciousness 111.5/146.75; atonic 1.9/1.6; generalized tonic 24.5/21.25; eyelid myoclonia 6.3/6; myoclonic tonic 9/7; absence with eyelid myoclonia 10/9; generalized clonic 14/15.25; atypical absence 44.25/50; generalized tonic-clonic 127/120.25; tonic spasm 15.5/15.5; typical absence 20/23.25; myoclonic absence 20.75/21.

Conclusions These data suggest an appropriate focus on absence, tonic-clonic and focal seizures as being more prolonged and support the 2 minutes cutoff for tonic-clonic seizures (focal/generalized onset). However, the statistical cutoff of ~1 minute for absence seizures and 1-2 minutes for focal seizures suggests the consensus definition may be too conservative at 2 and 5 minutes, respectively. Focal preserved consciousness seizures may become prolonged from 1 minute, and focal impaired consciousness seizures from 2 minutes. Other generalized seizure types may become abnormally prolonged earlier.

Authors/Disclosures
Cedric Laloyaux, PhD (UCBMedical Affairs Center of Expertise) PRESENTER	Dr. Laloyaux has received personal compensation for serving as an employee of UCB.
Bersabeh B. Sile	Miss Sile has nothing to disclose.
Pirgit M. Larsen, MD	Dr. Larsen has nothing to disclose.
Anna Kuba	Ms. Kuba has received personal compensation for serving as an employee of UCB.
Sami Elmoufti, MBBS	Dr. Elmoufti has nothing to disclose.
Jenna S. Roberts, PhD	Dr. Roberts has received personal compensation for serving as an employee of UCB Pharma. Dr. Roberts has stock in UCB Pharma.
Eugen Trinka	Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai. Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bial. Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GW Pharmaceuticals. The institution of Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Rapport. The institution of Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbott. The institution of Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. Eugen Trinka has received research support from European Union. Eugen Trinka has received publishing royalties from a publication relating to health care.
Sandor Beniczky, MD, PhD (Aarhus University & Danish Epilepsy Center)	Prof. Beniczky has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Eisai. Prof. Beniczky has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for UCB. Prof. Beniczky has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Lundbeck. Prof. Beniczky has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for GW. The institution of Prof. Beniczky has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for ILAE.

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