A Descriptive Analysis of Prognostic Indicators in Patients with Non-Convulsive Status Epilepticus in a Tertiary Hospital Population

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DOI: 10.4236/nm.2012.31005    2,322 Downloads   4,737 Views  


Background: Non-convulsive status epilepticus (NCSE) is defined as a change in mental state of at least 30 minutes associated with continuous or nearly continuous epileptiform discharges. Identification of prognostic indicators can guide decision making surrounding the use of poorly established treatment interventions in this heterogeneous population. Methods: We identified 66 consecutive inpatients with NCSE. Data surrounding clinical, electrographic, and treatment factors were collected via a retrospective systematic review of medical records and electronic EEGs, and were correlated with discharge outcome (return to baseline, new disability, or death). Results: Of all subjects, 21% returned to baseline, 26% acquired new disability, and 53% died, of whom half had anoxic encephalopathy. On univariate analysis, seventeen variables correlated significantly with death, although multivariate logistic regression analysis subsequently identified only comatose state and number of life threatening comorbidities as independent predictors of mortality. Of survivors, comatose state, critical care environment, length of hospital stay, and acute symptomatic seizures predicted new disability, with the latter two showing independent significance. Following exclusion of cases with anoxic encephalopathy, the use of an anaesthetic infusion was also an independent predictor of mortality. Conclusions: NCSE is associated with variable morbidity and mortality. While one fifth of our NCSE patients returned to baseline, those comatose with acute structural/metabolic seizures, anaesthetic infusions, and life threatening comorbidities were unlikely to survive without disability at discharge.

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C. Hrazdil, R. Alroughani and M. Javidan, "A Descriptive Analysis of Prognostic Indicators in Patients with Non-Convulsive Status Epilepticus in a Tertiary Hospital Population," Neuroscience and Medicine, Vol. 3 No. 1, 2012, pp. 26-36. doi: 10.4236/nm.2012.31005.


[1] J. N. Gaitanis and F. W. Drislane, “Status Epilepticus: A Review of Different Syndromes, Their Current Evalu- ation, and Treatment,” Neurologist, Vol. 9, No. 2, 2003, pp. 61-76. doi:10.1097/01.nrl.0000051445.03160.2e
[2] P. W. Kaplan, “The Clinical Features, Diagnosis, and pro-Gnosis of Nonconvulsive Status Epilepticus,” Neurologist, Vol. 11, No. 6, 2005, pp. 348-361. doi:10.1097/01.nrl.0000162954.76053.d2
[3] S. Riggio, “Nonconvulsive Status Epilepticus: Clinical Features and Diagnostic Challenge,” Psychiatric Clinics of North America, Vol. 28, No. 3, 2005, pp. 653-664.
[4] M. Walker, H. Cross, S. Smith, et al., “Nonconvulsive status epilepticus: Epilepsy Research Foundation Workshop Reports,” Epileptic Disorders, Vol. 7, No. 3, 2005, pp. 253-296.
[5] F. Rosenow, H. M. Hamer and S. Knake, “The Epidemiology of Convulsive and Nonconvulsive Status Epilepticus,” Epilepsia, Vol. 48, Suppl. 8, 2007, pp. 82-84. doi:10.1111/j.1528-1167.2007.01359.x
[6] R. Maganti, P. Gerber, C. Drees and S. Chung, “Nonconvulsive Status Epilepticus,” Epilepsy & Behavior, Vol. 12, No. 4, 2008, pp. 572-586. doi:10.1016/j.yebeh.2007.12.002
[7] H. Meierkord and M. Holtkamp, “Non-Convulsive Status Epilepticus in Adults: Clinical forms and Treatment,” Lancet Neurology, Vol. 6, No. 4, 2007, pp. 329-339. doi:10.1016/S1474-4422(07)70074-1
[8] E. Lothman, “The Biochemical Basis and Pathophysiology of Status Epilepticus,” Neurology, Vol. 40, Suppl. 2, 1990, pp. 13-23.
[9] B. S. Meldrum, R. A. Vigouroux and J. B. Brierley, “Systemic Factors and Epileptic Brain Damage. Prolonged Seizures in Paralyzed, Artificially Ventilated Baboons,” Archives of Neurology, Vol. 29, No. 2, 1973, pp. 82-87. doi:10.1001/archneur.1973.00490260026003
[10] T. Tomson, U. Lindbom and B. Y. Nilssonm, “Nonconvulsive Status Epilepticus in Adults: Thirty-Two Consecutive Patients from a General Hospital Population,” Epilepsi, Vol. 33, No. 5, 1992, pp. 829-835. doi:10.1111/j.1528-1157.1992.tb02190.x
[11] B. Litt, R. J. Wityk, S. H. Hertz, et al., “Nonconvulsive Status Epilepticus in the Critically Ill Elderly,” Epilepsia, Vol. 39, No. 11, 1998, pp. 1194-1202. doi:10.1111/j.1528-1157.1998.tb01311.x
[12] F. W. Drislane, “Evidence against Permanent Neurologic Damage from Nonconvulsive Status Epilepticus,” Journal of Clinical Neurophysiology, Vol. 16, No. 4, 1999, pp. 323-331. doi:10.1097/00004691-199907000-00004
[13] M. C. Walker, “Diagnosis and Treatment of Nonconvulsive Status Epilepticus,” CNS Drugs, Vol. 15, No. 12, 2001, pp. 931-939. doi:10.2165/00023210-200115120-00003
[14] B. F. Shneker and N. B. Fountain, “Assessment of Acute Morbidity and Mortality in Nonconvulsive Status Epilep- ticus,” Neurology, Vol. 61, No. 8, 2003, pp. 1066-1073.
[15] J. M. Murthy, “Nonconvulsive status epilepticus: An under Diagnosed and Potentially Treatable Condition,” Neurology India, Vol. 51, No. 4, 2003, pp. 453-454.
[16] D. M. Treiman, P. D. Meyers, N. Y. Walton, et al., “A Comparison of Four Treatments for Generalized Convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group,” New England Journal of Medicine, Vol. 339, 1998, pp. 792-798. doi:10.1056/NEJM199809173391202
[17] R. J. DeLorenzo, E. J. Waterhouse, A. R. Towne, et al., “Persistent Nonconvulsive Status Epilepticus after the Control of Convulsive Status Epilepticus,” Epilepsia, Vol. 39, No. 8, 1998, pp. 833-840. doi:10.1111/j.1528-1157.1998.tb01177.x
[18] A. O. Rossetti, S. Hurwitz, G. Logroscino and E. B. Bromfield, “Prognosis of Status Epilepticus: Role of Aetiology, Age, and Consciousness Impairment at Presentation,” Journal of Neurology, Neurosurgery & Psychiatry, Vol. 77, 2006, pp. 611-615. doi:10.1136/jnnp.2005.080887
[19] P. W. Kaplan, “Prognosis in Nonconvulsive Status Epilepticus,” Epileptic Disorders, Vol. 2, No. 4, 2000, pp. 185-193.
[20] F. J. Bottaro, O. A. Martinez, M. M. Pardal, J. E. Bruetman and R. C. Reisin, “Nonconvulsive Status Epilepticus in the Elderly: A Case-Control Study,” Epilepsia, Vol. 48, No. 5, 2007, pp. 966-972. doi:10.1111/j.1528-1167.2007.01033.x
[21] D. H. Lo-wenstein and M. J. Aminoff, “Clinical and EEG Features of Status Epilepticus in Comatose Patients,” Neurology, Vol. 42, No. 1, 1992, pp. 100-104.
[22] F. W. Drislane and D. L. Schomer, “Clinical Implications of Generalized Electrographic Status Epilepticus,” Epilepsy Research, Vol. 19, No. 2, 1994, pp. 111-121. doi:10.1016/0920-1211(94)90021-3
[23] J. Scozzafava, M. S. Hussain, P. G. Brindley, M. J. Jacka and D. W. Gross, “The Role of the Standard 20 Minute EEG Re-cording in the Comatose Patient,” Journal of Clinical Neuroscience, Vol. 17, No. 1, 2010, pp. 64-68.
[24] G. B. Young, K. G. Jordan and G. S. Doig, “An Assessment of Nonconvulsive Seizures in the Intensive Care Unit Using Continuous EEG Monitoring: An Investigation of Variables Associated with Mortality,” Neurology, Vol. 47, No. 1, 1996, pp. 83-89.
[25] D. J. Chong and L. J. Hirsch, “Which EEG Patterns Warrant Treatment in the Critically Ill? Reviewing the Evidence for Treatment of Periodic Epileptiform Discharges and Related Patterns,” Journal of Clinical Neurophysiology, Vol. 22, No. 2, 2005, pp. 79-91. doi:10.1097/01.WNP.0000158699.78529.AF
[26] P. W. Kaplan, “EEG Criteria for Nonconvulsive Status Epilepticus,” Epilepsia, Vol. 48, Suppl. 8, 2007, pp. 39- 41. doi:10.1111/j.1528-1167.2007.01345.x
[27] A. T. Berg, S. F. Berkovic, M. J. Brodie, et al., “Revised Terminology and Concepts for Organization of Seizures and Epilepsies: Report of the ILAE Commission on Classification and Terminology, 2005-2009,” Epilepsia, Vol. 51, No. 4, 2010, pp. 676-685. doi:10.1111/j.1528-1167.2010.02522.x
[28] J. W. Dunne, Q. A. Summers and E. G. Stewart-Wynne, “Non-Convulsive Status Epilepticus: A Prospective Study in an Adult General Hospital,” QJM, Vol. 62, No. 2, 1987, pp. 117-126.
[29] M. Siddiqui, N. Jamil, A. Malik, A. Bano, F. S. Khan and K. Siddiqui, “Frequency of Non Convulsive Status Epilepticus in Patients with Impaired Level of Consciousness,” Journal of the Pakistan Medical Association, Vol. 59, No. 5, 2009, pp. 296-298.
[30] A. R. Towne, E. J. Waterhouse, J. G. Boggs, et al., “Prevalence of Nonconvulsive Status Epilepticus in Comatose Patients,” Neurology, Vol. 54, No. 2, 2000, pp. 340-345.
[31] J. T. Narayanan and J. M. Murthy, “Nonconvulsive Status Epilepticus in a Neurological Intensive Care Unit: Profile in a Developing Country,” Epilepsia, Vol. 48, No. 5, 2007, pp. 900-906. doi:10.1111/j.1528-1167.2007.01099.x
[32] M. Privitera, M. Hoffman, J. L. Moore and D. Jester, “EEG Detection of Nontonic-Clonic Status Epilepticus in Patients with Altered Consciousness,” Epilepsy Research, Vol. 18, No. 2, 1994, pp. 155-166. doi:10.1016/0920-1211(94)90008-6
[33] G. B. Young and G. S. Doig, “Continuous EEG Monitoring in Comatose Intensive Care Patients: Epileptiform Activity in Etiologically Distinct Groups,” Neurocritical Care, Vol. 2, No. 1, 2005, pp. 5-10. doi:10.1385/NCC:2:1:005
[34] R. J. DeLorenzo, W. A. Hauser, A. R. Towne, et al., “A Prospective, Population-Based Epidemiologic Study of Status Epilepticus in Richmond, Virginia,” Neurology, Vol. 46, No. 4, 1996, pp. 1029-1035.
[35] F. B. Scholtes, W. O. Renier and H. Meinardi, “Non-Convulsive Status Epilepticus: Causes, Treatment, and Outcome in 65 Patients,” Journal of Neu-rology, Neuro- surgery & Psychiatry, Vol. 61, 1996, pp. 93-95. doi:10.1136/jnnp.61.1.93
[36] G. B. Young, J. J. Gilbert and D. W. Zochodne, “The Significance of Myoclonic Status Epilepticus in Post- anoxic Coma,” Neurology, Vol. 40, 1990, pp. 1843-1848.
[37] A. C. Hui, C. Cheng, A. Lam, V. Mok and G. M. Joynt, “Prognosis Following Postanoxic Myoclonus Status Epilepticus,” European Neurology, Vol. 54, No. 1, 2005, pp. 10-13. doi:10.1159/000086755
[38] W. D. Freeman, K. M. Barrett, M. L. Freeman, et al., “Predictors of Awakening from Postanoxic Status Epilepticus after Therapeutic Hypothermia,” Neurology, Vol. 73, 2009, pp. 1512-1513. doi:10.1212/WNL.0b013e3181bd6923
[39] A. O. Ros-setti, M. Oddo, L. Liaudet and P. W. Kaplan, “Predictors of Awakening from Postanoxic Status Epilep- ticus after Therapeutic Hypothermia,” Neurology, Vol. 72, No. 8, 2009, pp. 744-749. doi:10.1212/01.wnl.0000343006.60851.62
[40] F. Thomke and S. L. Weilemann, “Poor Prognosis Despite Successful Treatment of Postanoxic Generalized Myoc-lonus,” Neurology, Vol. 74, 2010, pp. 1392-1394. doi:10.1212/WNL.0b013e3181dad5b9
[41] A. O. Rossetti, G. Logroscino, L. Liaudet, et al., “Status Epilepticus: An Independent Outcome Predictor after Cerebral Anoxia,” Neurology, Vol. 69, No. 3, 2007, pp. 255- 260. doi:10.1212/01.wnl.0000265819.36639.e0
[42] A. O. Rossetti, G. Logroscino and E. B. Bromfield, “Refractory Status Epilepticus: Effect of Treatment Aggressiveness on Prognosis,” Archives of Neurology, Vol. 62, 2005, pp. 1698-1702. doi:10.1001/archneur.62.11.1698
[43] A. O. Rossetti, G. Logroscino and E. B. Bromfield, “A Clinical Score for Prognosis of Status Epilepticus in Adults,” Neurology, Vol. 66, No. 11, 2006, pp. 1736-1738. doi:10.1212/01.wnl.0000223352.71621.97
[44] P. W. Kaplan, “Nonconvulsive Status Epilepticus,” Neurology, Vol. 61, No. 8, 2003, pp. 1035-1036.
[45] F. W. Drislane, M. R. Lopez, A. S. Blum and D. L. Schomer, “Detection and Treatment of Refractory Status Epilepticus in the Intensive Care Unit,” J Clin Neuro- physiol., Vol. 25, No. 4, 2008, pp. 181-186. doi:10.1097/WNP.0b013e31817be70e
[46] M. A. Gran-ner and S. I. Lee, “Nonconvulsive Status Epilepticus: EEG Analysis in a Large Series,” Epilepsia, Vol. 35, No. 1, 1994, pp. 42-47. doi:10.1111/j.1528-1157.1994.tb02910.x
[47] J. Claassen, J. K. Lokin and B. F. Fitzsimmons, “Mendelsohn F. A., Mayer S. A. Predictors of functional Disability and Mortality after Status Epilepticus,” Neurology, Vol. 58, 2002, pp. 139-142.
[48] A. Krumholz, G. Y. Sung, R. S. Fisher, E. Barry, G. K. Bergey and L. M. Grattan, “Complex Partial Status Epilepticus Accompanied by Serious Morbidity and Mortality,” Neurology, Vol. 45, 1995, pp. 1499-1504.
[49] P. Thomas, A. Beaumanoir, P. Genton, C. Dolisi and M. Chatel, “De Novo Absence Status of Late Onset: Report of 11 Cases,” Neurology, Vol. 42, 1992, pp. 104-110.

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