Nonconvulsive Status Epilepticus in Patients with Altered Mental Status Admitted to Hamad General Hospital, Doha, Qatar

Mesraoua, Boulenouar; Deleu, Dirk; Hail, Hassan Al; Ali, Musab; Haddad, Naim; Melykian, Gayane; Ali, Yasser Osman M.; Sheikh, Lubna El; Asadi-Pooya, Ali A.; Kaplan, Peter W.

doi:10.5772/intechopen.83580

Cited by 2 publications

(3 citation statements)

References 46 publications

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“…Our study has also found the prevalence of any seizure activity and NCSE to be high (42.9% and 28.8%, respectively) 1,5,18 . NCSE was present in 58.9% of patients in whom any seizure activity was detected.…”

Section: Discussionsupporting

confidence: 69%

“…Our study has also found the prevalence of any seizure activity and NCSE to be high (42.9% and 28.8%, respectively). 1,5,18 NCSE was present in 58.9% of patients in whom any seizure activity was detected. The high prevalence of NCSE found in our study can be used to safely assume that their detection can be enhanced with the use of bedside EEGs.…”

Section: Discussionmentioning

confidence: 96%

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Prevalence of non‐convulsive seizures and electroencephalographic abnormalities in critically ill patients—A retrospective observational study

Karki,

Shrestha,

Shrestha

et al. 2023

Epilepsia Open

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ObjectiveElectroencephalographic (EEG) abnormalities especially non‐convulsive status epilepticus (NCSE) have been found to be associated with worse outcomes in critically ill patients. We aimed to assess the prevalence of non‐convulsive seizures and electroencephalographic abnormalities in critically ill patients. Furthermore, we aimed to investigate any association between the type of EEG abnormality and outcomes including ICU mortality and successful ICU discharge.MethodsThis was a cross‐sectional observational study carried out among critically ill patients in a mixed medical‐surgical ICU from January 1, 2018 to May 15, 2020. A total of 178 records of 30 min bedside EEG records were found. EEG findings were grouped as normal, non‐convulsive seizures (NCS), non‐convulsive status epilepticus (NCSE), and other abnormalities. Descriptive analytical tools were used to characterize the case details in terms of the type of EEG abnormalities. Chi square test was used to describe the EEG abnormalities in terms of mortality. The status epilepticus severity scores (STESS) were further calculated for records with NCSE. These data were then analyzed for any association between STESS and mortality for cases with NCSE.ResultsThe prevalence of EEG abnormality in our cohort of all critically ill patients was found to be 7.3% (170/2234). Among the patients with altered sensorium in whom EEG was done, 42.9% had non‐conclusive seizure activity with 25.2% in NCSE. Though the study was not adequately powered, there was a definite trend towards a lower proportion of successful ICU discharge rates seen among patients with higher STESS (>2) with only 33.3% being discharged for patients with a STESS of 6 versus 92.9% for those with STESS 3.SignificanceWhen combined with a strong clinical suspicion, even a 30‐min bedside EEG can result in detection of EEG abnormalities including NCS and NCSE. Hence, EEG should be regularly included in the evaluation of critically ill patients with altered sensorium.Plain Language SummaryElectroencephalographic (EEG) abnormalities and seizures can have high prevalence in critically ill patients. These abnormalities notably, non‐convulsive status epilepticus (NCSE) has been found to be associated with poor patient outcomes. This was a retrospective observational study analyzing 178 EEG records, from a mixed medical‐surgical ICU. The indication for obtaining an EEG was based solely on the clinical suspicion of the treating physician. The study found a high prevalence of EEG abnormalities in 96.5% in whom it was obtained with 42.9% having any seizure activity and 28.8% having NCSE. The study was not powered for detection of association of the EEG abnormalities with clinical outcomes. However, a definite trend towards decreased chances of successful discharge from the ICU was seen. This study used strong clinical suspicion in patients with altered sensorium to obtain an EEG. High detection rates of EEG abnormalities were recorded in this study. Hence, combination of clinical judgement and EEG can improve detection of EEG abnormalities and NCSE.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 96%

Prevalence of non‐convulsive seizures and electroencephalographic abnormalities in critically ill patients—A retrospective observational study

Karki,

Shrestha,

Shrestha

et al. 2023

Epilepsia Open

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“…In comatose patients, epileptiform discharges faster than 2.5 Hz or generalized periodic discharges (GPDs), lateralized periodic discharges (LPDs) and continuous 2/s GPDs with triphasic morphology of less than 2.5 Hz, as well as rhythmic Nonconvulsive Status Epilepticus and Coma DOI: http://dx.doi.org /10.5772/intechopen.89428 discharges (RDs) faster than 0.5 Hz were also taken into consideration as NCSE if they responded to benzodiazepine treatment with improvement in the EEG or mental status of patient (Figure 6) [26,27].…”

Section: Eeg Criteria For Ncse In the Comatose Patientsmentioning

confidence: 99%

Nonconvulsive Status Epilepticus and Coma

Algin¹,

Uncu²,

Adapınar³

et al. 2020

Disorders of Consciousness - A Review of Important Issues

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Nonconvulsive status epilepticus (NCSE) is common in patients with coma with a prevalence between 5 and 48%. Nonconvulsive status epilepticus (NCSE) is an electroclinical state associated with an altered mental status (AMS) but lacking convulsive motor activity. It is difficult to diagnose in the obtunded/comatose patients. Such patients have often other serious medical conditions, and the diagnosis of NCSE is frequently delayed in these patients. Diagnosing NCSE demands a high degree of clinical suspicion and for that reason likely remains under-recognized. The most important question, however, is whether the treatment of NCSE in coma improves the outcome of these patients or not. In this review, we aimed to summarize the EEG patterns in NCSE to further delineate the borders between comatose forms of NCSE and comaepileptiform discharges and to evaluate modified EEG criteria for NCSE in a coma.

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Nonconvulsive Status Epilepticus in Patients with Altered Mental Status Admitted to Hamad General Hospital, Doha, Qatar

Cited by 2 publications

References 46 publications

Prevalence of non‐convulsive seizures and electroencephalographic abnormalities in critically ill patients—A retrospective observational study

Prevalence of non‐convulsive seizures and electroencephalographic abnormalities in critically ill patients—A retrospective observational study

Nonconvulsive Status Epilepticus and Coma

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