Assessment of cerebral blood flow changes in nonconvulsive status epilepticus in comatose patients: A pathophysiological transcranial Doppler study

Merceron, Sybille; Geeraerts, Thomas; Montlahuc, Claire; Bédos, Jean‐Pierre; Resche-Rigon, Matthieu; Legriel, Stéphane

doi:10.1016/j.seizure.2014.01.001

Cited by 11 publications

(16 citation statements)

References 40 publications

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“…In contrast to the presented data, a compromised CA was described in epilepsy patients in interictal states [1]. Furthermore, CBFV was increased during tonic-clonic seizures but was not observable during SE and nonconvulsive SE in comatose patients [4, 5]. Neither an increased CBFV nor alterations of CA were found; this may be attributable to sufficient seizure treatment due to analgo-sedation.…”

contrasting

confidence: 58%

Intact cerebrovascular autoregulation in patients with refractory status epilepticus due to sufficient anesthetic treatment on a neurointensive care unit: a prospective cohort study

et al. 2019

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contrasting

confidence: 58%

Intact cerebrovascular autoregulation in patients with refractory status epilepticus due to sufficient anesthetic treatment on a neurointensive care unit: a prospective cohort study

et al. 2019

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“…According to this concept, the state of hyperperfusion demonstrated in vascular and perfusion studies in cases of NCSE and IIC can be understood [8,[11][12][13]. However, with prolonged and persistent epileptic activity, the increase of CBF becomes insufficient to meet the metabolic needs of the exhausted tissue, with progressive mitochondrial and energy failure and uncoupling state or homeostatic failure ensues, which participates in secondary neuronal injury, perpetuating the epileptic activity.…”

Section: Ncse: Cerebral Hemodynamics Changesmentioning

confidence: 99%

Non-Convulsive Status Epilepticus (NCSE) in ICU: Bedside Usefulness of TCD in Comatose Patient Diagnosis. When the EEG Is Too Far

Othman

Abd‐Allah

2021

Neurosonology in Critical Care

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Points 1. Nonconvulsive status epilepticus (NCSE) is an important cause for unexplained impairment of consciousness, particularly in the intensive care unit (ICU). 2. Generation of abnormally prolonged or repeatedly recurrent brain electrical activity represents a metabolic burden not only on the neurons but also on the glial cells. This should be coupled by increase in cerebral blood flow (CBF). 3. The merits of the TCCS (transcranial color-coded duplex sonography) are being available, fast, bedside, safe, repeatable, and not interfering with continuous monitoring in the ICU. 4. TCCS assessment can help not only in diagnosis and follow-up of NCSE/IIC, but also in identifying the underlying etiology: arterial stenosis as a cause of acute ischemic stroke (AIS), dural venous sinus thrombosis, hydrocephalus, increased of ICP (by MLS, ONSD, and papilledema measurements) as in cases caused of space-occupying lesions (SOLs) (neoplasms, intra-and extra-axial hematoma, etc.). 5. Indirect assessment of cerebral blood flow (CBF) through cerebral blood flow velocities (CBFVs) measurement using TCD/TCCS was the most studied application of neurosonology in epileptic seizures, due to its ability to provide realtime evaluation at bedside. 6. EEG is the gold standard for diagnosis of NCSE/IIC; however, it can be unavailable or not conclusive enough. In these cases, vascular imaging can help to establish the diagnosis.

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“…In the last few years, many experimental and clinical studies have been conducted on neurovascular coupling. Real-time TCD-video EEG (vEEG) has been used as the first choice to assess instantaneous haemodynamic changes as well as neurovascular coupling in patients with epilepsy (Rosengarten et al, 2012;Merceron et al, 2014). Absence seizures refer to a sudden paroxysmal loss of consciousness, related to bursts of bilateral, synchronous 3-3.5-Hz spike-and-wave discharges recorded on EEG (Proposal for revised classification of epilepsies and epileptic syndromes, 1989).…”

Section: Ictal Cerebral Haemodynamic During Absence Seizuresmentioning

confidence: 99%

Ictal cerebral haemodynamic characteristics during typical absence seizures, compared to focal seizures with brief alteration of awareness

Peng

Dai

et al. 2019

Epileptic Disorders

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Aims . To investigate ictal cerebral haemodynamic characteristics during spontaneous typical absence seizures (TAS) and hyperventilation‐evoked absence seizures in paediatric patients, relative to brief complex partial seizures (BCPS). Methods . All children diagnosed with seizures using real‐time transcranial doppler ultrasonography (TCD) and sleep‐deprived video‐EEG (vEEG) from 2015 to 2017 in our hospital were included. The seizures were diagnosed based on the video and EEG findings. Mean cerebral blood flow velocity (CBFV m ) of the unilateral middle cerebral artery was measured using TCD. TCD and vEEG data were integrated for a synchronous assessment of CBFV m changes and epileptic status. Baseline and peak CBFV m for TAS and BCPS were compared by T‐test. Results . Six children (two boys and four girls) with TAS and two girls with BCPS were enrolled. A total of 15 spontaneous TAS, 14 hyperventilation‐evoked absence seizures, and six BCPS were recorded using real‐time TCD‐vEEG monitoring. During spontaneous TAS, whether awake or asleep, the CBFV m decreased by 20–40% compared to baseline. During hyperventilation‐evoked absence seizures and BCPS, the CBFV m increased by 50–150% and 20–30% over baseline levels, respectively. Conclusions . The haemodynamic characteristics during TAS and BCPS are distinct, and thus our results may provide a new method to diagnose typical absence seizures using dynamic CBFV m curves. Ictal cerebral haemodynamic characteristics during spontaneous typical absence seizures and hyperventilation‐evoked absence seizures may reflect different pathophysiological mechanisms and networks compared with BCPS.

show abstract

Assessment of cerebral blood flow changes in nonconvulsive status epilepticus in comatose patients: A pathophysiological transcranial Doppler study

Cited by 11 publications

References 40 publications

Intact cerebrovascular autoregulation in patients with refractory status epilepticus due to sufficient anesthetic treatment on a neurointensive care unit: a prospective cohort study

Intact cerebrovascular autoregulation in patients with refractory status epilepticus due to sufficient anesthetic treatment on a neurointensive care unit: a prospective cohort study

Non-Convulsive Status Epilepticus (NCSE) in ICU: Bedside Usefulness of TCD in Comatose Patient Diagnosis. When the EEG Is Too Far

Ictal cerebral haemodynamic characteristics during typical absence seizures, compared to focal seizures with brief alteration of awareness

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