Nonconvulsive Status Epilepticus in the Critically Ill Elderly

Litt, Brian; Wityk, Robert J.; Hertz, Sharon; Mullen, Paul; Weiss, Howard D.; Ryan, D.; Henry, Thomas R.

doi:10.1111/j.1528-1157.1998.tb01311.x

Cited by 246 publications

(187 citation statements)

References 19 publications

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“…The incidence of NCS in this model is 81%, the mean number of NCS/animal is 10.6 over a 2 hour observation period, and the mean duration of each episode is 60 sec (Hartings et al, 2003b). The occurrence and duration of NCS in brain injured patients are critical determinants of outcome and mortality (Jordan, 1995;Litt et al, 1998;Young et al, 1996). Although electric seizures and acute brain injury work synergistically to worsen outcome, the underlying pathomechanism is still unclear.…”

Section: Discussionmentioning

confidence: 92%

Alpha-chloralose is a suitable anesthetic for chronic focal cerebral ischemia studies in the rat: A comparative study

2008

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Abstractα-chloralose is widely used as an anesthetic in studies of the cerebrovasculature because it provides robust metabolic and hemodynamic responses to functional stimulation. However, there have been no controlled studies of focal ischemia in the rat under α-chloralose anesthesia. Artificially ventilated rats were prepared using 1.2−1.5 % isoflurane anesthesia for filament occlusion of the right middle cerebral artery (MCA), and anesthesia was either switched to α-chloralose (60 mg/kg bolus, 30 mg/ kg/hr; n=10) or was maintained on 1% isoflurane (n=10). Following temporary MCA occlusion EEG was monitored from a screw electrode and changes in cerebral blood flow (rCBF) measured with a laser Doppler probe placed over the ischemic cortex. This study shows that α-chloralose is a safe anesthetic for ischemia studies and provides excellent survival. Compared with isoflurane, the cortical and total infarct volumes are larger in the α-chloralose anesthetized animals, while the functional outcome at 72 hours is similar. The total duration of peri-infarct flow transients (PIFTs) is also significantly longer in α-chloralose anesthetized animals. The average amplitude of the flow transients showed a good correlation with the extent of edema in all animals as did the total duration of non-convulsive seizures (NCS) in the α-chloralose anesthetized animals.

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Section: Discussionmentioning

confidence: 92%

Alpha-chloralose is a suitable anesthetic for chronic focal cerebral ischemia studies in the rat: A comparative study

2008

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“…Five patients had both clinical and subclinical seizures. In a series by Litt et al (12) of critically ill elderly patients, 24 patients were described to have nonconvulsive status epilepticus, but only two patients had a history of a known seizure disorder. In our series, three of the patients with subclinical seizures did not have a history of epilepsy, but the typical patient admitted to an EMU is not critically ill, representing a different patient population.…”

Section: Discussionmentioning

confidence: 99%

Video‐EEG Monitoring in the Elderly: A Review of 94 Patients

2002

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Summary:Purpose: We sought to determine the utility and results of video-EEG monitoring in elderly patients. There is an increased incidence of epilepsy in the elderly population. Few studies have assessed the characteristics of epileptic and nonepileptic seizures in this age group. Diagnostic evaluation with video-EEG monitoring is a means to distinguish these different types of events.Methods: The authors reviewed all patients aged 60 years and older who were admitted to the epilepsy monitoring unit at Columbia-Presbyterian Medical Center from January 21, 1991, to April 12, 1999.Results: A total of 94 patients and 99 patient admissions were identified, accounting for 8% of all admissions. The average age was 70 years, and the mean length of stay was 3.8 days. Typical events were recorded in 75 of the 99 patient admissions. A total of 118 seizures was recorded in 46 patients, and 98 nonepileptic events were seen in 27 patients. Of the patients with nonepileptic events, 13 had psychogenic seizures. The majority of patients with nonepileptic events were taking antiepileptic medication. Whereas 76% of the patients with epileptic events had interictal epileptiform discharges, 26% of the patients with nonepileptic events had epileptiform discharges as well.Conclusions: Video-EEG monitoring in the elderly leads to a definitive diagnosis in the majority of patients in a relatively short time. Interictal recordings are inadequate in determining the nature of paroxysmal events. Nonepileptic events are common in the elderly, including psychogenic seizures, and these are often misdiagnosed and mistreated as epileptic seizures.

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“…Even so, in some cases, excessive and overly aggressive treatment of seizures has also been reported to result in worsening of outcomes. 10 Several studies in animals have clearly shown the importance of treating non-convulsive seizures, which may be associated with increased metabolic, oxidative, and excitotoxic stress on brain at-risk, [13][14][15] and thus may result in irreversible neuronal injury. The management of NCSE is less clear in patients in whom NCSE presents as a manifestation of a serious underlying illness.…”

Section: Discussionmentioning

confidence: 99%