Frequency and Types of Complications Encountered in Patients With Nonconvulsive Status Epilepticus in the Neurological ICU: Impact on Outcome

Abstract

Objectives. The frequency and types of complications in patients with nonconvulsive status epilepticus (NCSE) who are followed up in the intensive care unit (ICU), and the impact of these complications on outcome are not well-known. We investigated the complications and their effects on prognosis in NCSE patients. Methods. After reviewing the video-EEG monitoring (VEEGM) reports of all the consecutive patients who were followed up in our ICU between 2009 and 2019, we identified two groups of patients: 1-patients with NCSE (study group) and 2-patients who underwent VEEGM for possible NCSE but did not have ictal recordings (no-NCSE group). Electronic health records were reviewed to identify demographic and clinical data, duration of ICU care, medical and surgical complications, pharmacologic treatment, and outcome. These parameters were compared statistically between the groups. We also investigated the parameters affecting prognosis at discharge. Results. Thirty-two patients with NCSE comprised the study group. Infection developed in 84%. More than half were intubated, had tracheostomy or percutaneous endoscopic gastrostomy application. Refractory NCSE was associated with significantly more frequent complications and worse outcome. There was a higher tendency of infections in the study group ( P = .059). Higher organ failure scores and prolonged stay in ICU predicted worse outcome ( P < .05). Conclusion. The frequency of complications in patients with NCSE who are cared for in the ICU is considerable. Most of the complications are similar to the other patients in ICU, except for the higher frequency of infections. Increased physician awareness about modifiable parameters and timely interventions might help improve prognosis.

Treatment of Refractory Status Epilepticus With Continuous Intravenous Anesthetic Drugs

“…A total of 3603 publications were identified by search of Embase, PubMed, Ovid MEDLINE, and Web of Science, of which 66 publications were included (eFigure 1 in the Supplement). Other than 4 randomized clinical trials that included 32 patients, 23 patients, 23 patients, and 10 patients, and a retrospective case-control study with 33 patients, all remaining eligible studies were case cohort or case series (Table 1).…”

“…Other than 4 randomized clinical trials that included 32 patients, 23 patients, 23 patients, and 10 patients, and a retrospective case-control study with 33 patients, all remaining eligible studies were case cohort or case series (Table 1). Furthermore, based on our inclusion criteria (5 or more patients and at least 1 patient older than 12 years with a diagnosis of RSE), only 2 patients in the study by Mahvelati et al and 3 in the study by Rosati et al were included because other patients in these studies were younger than 12 years.…”

“…Fourteen patients were counted twice as described previously because 2 CIVADs were initiated simultaneously on these patients (Table 1). Our study included 4 publications totaling 103 patients (midazolam: 35 of 838; propofol: 22 of 619; barbiturates: 46 of 170) since 1994 that were also included in the Claassen study . We excluded 1 patient who received continuous intravenous phenobarbital from analysis due to the paucity of data.…”

“…We extracted data from 70 patients older than 12 years from 14 publications that included pediatric patients (Table 1). …”

“…Only descriptive statistics were used to analyze type of EEG use and treatment goals because a large proportion of studies had unclear/unknown or mixed monitoring and treatment goals, which precluded meaningful statistical analyses (Table 2). The rate of continuous EEG (CEEG) monitoring was higher in publications after 2010 (pre-2010: continuous: 76%, 244 of 321 patients; intermittent: 24%, 77 of 321 patients; and 2010 onward: continuous: 89%, 493 of 555 patients; intermittent: 11%, 62 of 555 patients). The type of EEG monitoring was unknown/unclear for 45% of patients.…”