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Krejzar Z, Sila D, Waldauf P, Kuriscak E, Mokrejs P, Spatenkova V. Impact of frailty, biomarkers and basic biochemical parameters on outcomes of comatose patients in status epilepticus: a single-center prospective pilot study. BMC Neurol 2024; 24:46. [PMID: 38279084 PMCID: PMC10811840 DOI: 10.1186/s12883-024-03537-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/14/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Status epilepticus (SE) is a severe acute condition in neurocritical care with high mortality. Searching for risk factors affecting the prognosis in SE remains a significant issue. The primary study's aim was to test the predictive values of the Clinical Frailty Scale (CFS) and the Modified 11-item Frailty Index (mFI-11), the biomarkers and basic biochemical parameters collected at ICU on the Glasgow Outcome Scale (GOS) assessed at hospital discharge (hosp), and three months later (3 M), in comatose patients with SE. The secondary aim was to focus on the association between the patient's state at admission and the duration of mechanical ventilation, the ICU, and hospital stay. METHODS In two years single-centre prospective pilot study enrolling 30 adult neurocritical care patients with SE classified as Convulsive SE, A.1 category according to the International League Against Epilepsy (ILAE) Task Force without an-/hypoxic encephalopathy, we evaluated predictive powers of CFS, mFI-11, admission Status Epilepticus Severity Score (STESS), serum protein S100, serum Troponin T and basic biochemical parameters on prognosticating GOS using univariate linear regression, logistic regression and Receiver Operating Characteristic (ROC) analysis. RESULTS Our study included 60% males, with a mean age of 57 ± 16 years (44-68) and a mean BMI of 27 ± 5.6. We found CFS, mFI-11, STESS, and age statistically associated with GOS at hospital discharge and three months later. Among the biomarkers, serum troponin T level affected GOS hosp (p = 0.027). Serum C-reactive protein significance in prognosticating GOS was found by logistic regression (hosp p = 0.008; 3 M p = 0.004), and serum calcium by linear regression (hosp p = 0.028; 3 M p = 0.015). In relation to secondary outcomes, we found associations between the length of hospital stay and each of the following: age (p = 0.03), STESS (p = 0.009), and serum troponin T (p = 0.029) parameters. CONCLUSIONS This pilot study found promising predictive powers of two frailty scores, namely CFS and mFI-11, which were comparable to age and STESS predictors regarding the GOS at hospital discharge and three months later in ICU patients with SE. Among biomarkers and biochemical parameters, only serum troponin T level affected GOS at hospital discharge.
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Affiliation(s)
- Zdenek Krejzar
- Department of Neurology, First Faculty of Medicine, Charles University in Prague, Katerinska 1660/32, Prague 2, 121 08, Czech Republic
- Centrum of Anaesthesiology, Resuscitation and Intensive Care, Regional Hospital, Husova 357/10, Liberec, 46001, Czech Republic
| | - David Sila
- Centrum of Anaesthesiology, Resuscitation and Intensive Care, Regional Hospital, Husova 357/10, Liberec, 46001, Czech Republic
- Emergency Medical Services, Klasterni 954/5, Liberec, 460 01, Czech Republic
- Faculty of Health Studies, Technical University in Liberec, Studentska 1402/2, 461 17, Liberec 1, Czech Republic
| | - Petr Waldauf
- Department of Anaesthesiology and Resuscitation, Third Faculty of Medicine, Charles University in Prague, Ruska 10, Prague, 100 00, Czechia
- University Hospital Kralovske Vinohrady, 110 34 Prague 10, Srobarova, 1050, Czech Republic
| | - Eduard Kuriscak
- Institute of Physiology, First Faculty of Medicine, Charles University in Prague, Albertov 5, Prague, 128 00, Czech Republic
| | - Petr Mokrejs
- Department of Neurology, First Faculty of Medicine, Charles University in Prague, Katerinska 1660/32, Prague 2, 121 08, Czech Republic
- Emergency Medical Services, Klasterni 954/5, Liberec, 460 01, Czech Republic
| | - Vera Spatenkova
- Faculty of Health Studies, Technical University in Liberec, Studentska 1402/2, 461 17, Liberec 1, Czech Republic.
- Department of Anaesthesiology and Resuscitation, Third Faculty of Medicine, Charles University in Prague, Ruska 10, Prague, 100 00, Czechia.
- University Hospital Kralovske Vinohrady, 110 34 Prague 10, Srobarova, 1050, Czech Republic.
- Institute of Physiology, First Faculty of Medicine, Charles University in Prague, Albertov 5, Prague, 128 00, Czech Republic.
- Neurocenter, Neurointensive Care Unit, Regional Hospital, Husova 357/10, Liberec, 46001, Czech Republic.
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Brigo F, Zaboli A, Giovannini G, Lattanzi S, Orlandi N, Turcato G, Meletti S. Comparison of the status epilepticus severity score and the epidemiology-based mortality score in predicting 30-day mortality and status epilepticus cessation. Epilepsy Behav 2023; 147:109388. [PMID: 37625347 DOI: 10.1016/j.yebeh.2023.109388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVE To evaluate the role of the Status Epilepticus Severity Score (STESS) and the Epidemiology-based Mortality score (EMSE) in predicting 30-day mortality and SE (Status epilepticus) cessation, and their prognostic performance in subgroups of patients with specific characteristics. METHODS We reviewed consecutive episodes of SE occurring in patients aged ≥14 years at Baggiovara Civil Hospital (Modena, Italy) from 2013 to 2021. We evaluated the predictive accuracy of EMSE and STESS for 30-day mortality and SE cessation through stepwise regression binary logistic models adjusted for possible univariate clinical confounders. RESULTS Seven hundred and eleven patients were enrolled. The mean value of STESS was 3.2 (SD 1.7) and of EMSE was 80.1 (SD 52.6). Within 30 days of the onset of SE, 28.4% of patients (202/711) died. EMSE had higher discriminatory ability for 30-day mortality compared with STESS (AUROC: 0.799; 95% CI: 0.765-0.832 versus 0.727; 95% CI: 0.686-0.766, respectively; p = 0.014). SE cessation within 1 h for convulsive SE and within 12 h for nonconvulsive SE was achieved in 35.3% (251/711) of patients. No significant difference was found between EMSE and STESS in discriminatory ability for SE cessation (AUROC: 0.516; 95% CI: 0.488-0.561 and 0.518; 95% CI: 0.473-0.563, respectively; p = 0.929). EMSE was superior to STESS in predicting 30-day mortality in patients with specific characteristics. No difference between the two scores was found in predicting SE cessation in subgroups of patients with specific characteristics. CONCLUSIONS EMSE seems superior to STESS in predicting 30-day mortality, particularly in specific patient categories. Conversely, there is no difference in the ability of these scores in predicting SE cessation, which is overall rather low.
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Affiliation(s)
- Francesco Brigo
- Hospital of Merano-Meran (SABES-ASDAA), Department of Neurology, Merano-Meran, Italy; Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria; Innovation, Research and Teaching Service (SABES-ASDAA), Bolzano-Bozen, Italy.
| | - Arian Zaboli
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria; Hospital of Merano-Meran (SABES-ASDAA), Department of Emergency Medicine, Merano-Meran, Italy
| | - Giada Giovannini
- Azienda Ospedaliera-Universitaria di Modena, Neurology Department, Modena, Italy; University of Modena and Reggio-Emilia, PhD Programme in Clinical and Experimental Medicine, Modena, Italy
| | - Simona Lattanzi
- Marche Polytechnic University, Neurological Clinic, Department of Experimental and Clinical Medicine, Ancona, Italy
| | - Niccolò Orlandi
- Azienda Ospedaliera-Universitaria di Modena, Neurology Department, Modena, Italy; University of Modena and Reggio-Emilia, Department of Biomedical, Metabolic, and Neural Sciences, Modena and Reggio-Emilia, Italy
| | - Gianni Turcato
- Hospital of Santorso (AULSS-7), Department of Internal Medicine, Santorso, Italy
| | - Stefano Meletti
- University of Modena and Reggio-Emilia, PhD Programme in Clinical and Experimental Medicine, Modena, Italy; University of Modena and Reggio-Emilia, Department of Biomedical, Metabolic, and Neural Sciences, Modena and Reggio-Emilia, Italy.
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Lattanzi S, Trinka E, Brigo F, Meletti S. Clinical scores and clusters for prediction of outcomes in status epilepticus. Epilepsy Behav 2023; 140:109110. [PMID: 36758360 DOI: 10.1016/j.yebeh.2023.109110] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 02/09/2023]
Abstract
Status epilepticus (SE) is a life-threatening condition and may have long-term negative sequelae. Short- and long-term outcomes encompass mortality, deterioration of functional status compared to baseline, refractoriness to treatment, recurrence of SE, and development of epilepsy, cognitive impairment, and behavioral disturbances. So far, the greatest amount of evidence is available for the prediction of short-term mortality. Conversely, the knowledge regarding long-term consequences among SE survivors is still scarce and several issues have not yet been resolved. The heterogeneity of SE renders the prognostication of outcomes challenging. Although aetiology is the main determinant of the outcome, different prognostic predictors have been identified. In this regard, data on group effects need to be integrated into prognostic scores to allow individual risk stratification. Importantly, many of the present scores are not designed to enable repetition to follow patient evolution. A new paradigm for the assessment of SE outcomes should consider variables that become available and/or can be retested during the course of SE. Neuroimaging findings, serum biomarkers, treatment characteristics, complications during SE, peri-ictal and postictal characteristics after SE cessation look as promising determinants of outcome and are suitable for inclusion in future models to enhance the quality and increase the reliability of prediction. This paper was presented at the 8th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures held in September 2022.
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Affiliation(s)
- Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy.
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Center for Cognitive Neuroscience, Salzburg, Austria; Public Health, Health Services Research and HTA, University for Health Sciences, Medical Informatics and Technology, Hall i.T, Austria
| | - Francesco Brigo
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Italy; Division of Neurology, "Franz Tappeiner" Hospital, Merano (BZ), Italy
| | - Stefano Meletti
- Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy; Department of Biomedical, Metabolic and Neural Science, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
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Kälviäinen R, Allal Z, Kantanen AM. When is it time for palliative and end-of-life care in status epilepticus? Epilepsy Behav 2023; 141:109058. [PMID: 36604196 DOI: 10.1016/j.yebeh.2022.109058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 01/07/2023]
Abstract
Status epilepticus (SE) is a neurological emergency characterized by high rates of short-term and long-term morbidity and mortality. Status epilepticus seems to be a marker of the severity of other underlying conditions rather than a determinant of death on its own. Careful diagnosis and acute treatment of complications and causes of death to SE or its underlying etiology will enable the differentiation of SE patients that would benefit from different levels of treatment intensity. All SE patients should be treated actively with first- and second-line drugs as early as possible. For cases in which seizures continue after second-line treatment, the current guidelines fail to offer possibilities other than the active path with general anesthesia and intensive care unit (ICU) care. However, the intensity of care should be evaluated before starting ICU care or in unclear cases with the time-limited trial at ICU. There are now multiple possibilities for specialty palliative SE care that include sequential and add-on use of second-line drugs and palliative sedation at the ward. If ICU care is prolonged, the patient's status needs to be constantly re-evaluated and communicated to the family. When patients exhibit multiple predictors of mortality and poor functional outcomes, they should be allowed to have a natural death in a peaceful environment without unnecessarily prolonged suffering. This paper was presented at the 8th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures held in September 2022.
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Affiliation(s)
- Reetta Kälviäinen
- Kuopio Epilepsy Center, Neurocenter, Kuopio University Hospital, Member of ERN EpiCARE, Kuopio, Finland; Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
| | - Zakarya Allal
- Kuopio Epilepsy Center, Neurocenter, Kuopio University Hospital, Member of ERN EpiCARE, Kuopio, Finland; Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anne-Mari Kantanen
- Kuopio Epilepsy Center, Neurocenter, Kuopio University Hospital, Member of ERN EpiCARE, Kuopio, Finland; Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Brigo F, Turcato G, Lattanzi S, Orlandi N, Turchi G, Zaboli A, Giovannini G, Meletti S. Retrospective External Validation of the Status Epilepticus Severity Score (STESS) to Predict In-hospital Mortality in Adults with Nonhypoxic Status Epilepticus: A Machine Learning Analysis. Neurocrit Care 2022; 38:254-262. [PMID: 36229575 DOI: 10.1007/s12028-022-01610-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/09/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The objective of this study was to validate the value of the Status Epilepticus Severity Score (STESS) in the prediction of the risk of in-hospital mortality in patients with nonhypoxic status epilepticus (SE) using a machine learning analysis. METHODS We included consecutive patients with nonhypoxic SE (aged ≥ 16 years) admitted from 2013 to 2021 at the Modena Academic Hospital. A decision tree analysis was performed using in-hospital mortality as a dependent variable and the STESS predictors as input variables. We evaluated the accuracy of STESS in predicting in-hospital mortality using the area under the receiver operating characteristic curve (AUROC) with 95% confidence interval (CI). RESULTS Among 629 patients with SE, the in-hospital mortality rate was 23.4% (147 of 629). The median STESS in the entire cohort was 2.9 (SD 1.6); it was lower in surviving compared with deceased patients (2.7, SD 1.5 versus 3.9, SD 1.6; p < 0.001). Of deceased patients, 82.3% (121 of 147) had scores of 3-6, whereas 17.7% (26 of 147) had scores of 0-2 (p < 0.001). STESS was accurate in predicting mortality, with an AUROC of 0.688 (95% CI 0.641-0.734) only slightly reduced after bootstrap resampling. The most significant predictor was the seizure type, followed by age and level of consciousness at SE onset. Nonconvulsive SE in coma and age ≥ 65 years predicted a higher risk of mortality, whereas generalized convulsive SE and age < 65 years were associated with a lower risk of death. The decision tree analysis using STESS variables correctly classified 90% of survivors and 34% of nonsurvivors after the SE, with an overall risk of error of 23.1%. CONCLUSIONS This validation study using a machine learning system showed that STESS is a valuable prognostic tool. The score appears particularly accurate and effective in identifying patients who are alive at discharge (high negative predictive value), whereas it has a lower predictive value for in-hospital mortality.
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Affiliation(s)
- Francesco Brigo
- Department of Neurology, Hospital of Merano-Meran, Merano-Meran, Italy
| | - Gianni Turcato
- Department of Internal Medicine, Hospital of Santorso, Santorso, Italy
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Niccolò Orlandi
- Neurology Department, Azienda Ospedaliera-Universitaria di Modena, Modena, Italy
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio-Emilia, Modena and Reggio-Emilia, Italy
| | - Giulia Turchi
- Neurology Department, Azienda Ospedaliera-Universitaria di Modena, Modena, Italy
| | - Arian Zaboli
- Department of Emergency Medicine, Hospital of Merano-Meran, Merano-Meran, Italy
| | - Giada Giovannini
- Neurology Department, Azienda Ospedaliera-Universitaria di Modena, Modena, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio-Emilia, Modena, Italy
| | - Stefano Meletti
- Neurology Department, Azienda Ospedaliera-Universitaria di Modena, Modena, Italy.
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio-Emilia, Modena and Reggio-Emilia, Italy.
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Monsson OS, Roberg LE, Gesche J, Beier CP, Krøigård T. Salzburg consensus criteria are associated with long-term outcome after non-convulsive status epilepticus. Seizure 2022; 99:28-35. [DOI: 10.1016/j.seizure.2022.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 12/12/2022] Open
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Development and Validation of a Nomogram Based on the Epidemiology-Based Mortality Score in Status Epilepticus (EMSE) Parameters to Predict 30-day Mortality in Status Epilepticus. Neurocrit Care 2022; 37:754-760. [PMID: 35778648 DOI: 10.1007/s12028-022-01548-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/04/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND To develop a nomogram using the parameters of the Epidemiology-Based Mortality Score in Status Epilepticus (EMSE) and to evaluate its accuracy compared with the EMSE alone in the prediction of 30-day mortality in patients with status epilepticus (SE). METHODS We included a cohort of patients with SE aged ≥ 21 years admitted from 2013 to 2021. Regression coefficients from the multivariable logistic regression model were used to generate a nomogram predicting the risk of 30-day mortality. Discrimination of the nomogram was evaluated using the area under the receiver operating characteristic curve (AUCROC) with 95% confidence interval. Internal validation was performed by bootstrap resampling. RESULTS Among 698 patients with SE, the 30-day mortality rate was 28.9% (202 of 698). On the multivariable analysis, all EMSE parameters (except for the comorbidity group including metastatic solid tumor or AIDS) were associated with a significantly higher risk of 30-day mortality and were included in the nomogram. The discriminatory capability of the nomogram with bootstrap resampling (5000 resamples) had an AUCROC of 0.830 (95% confidence interval 0.798-0.862). Conversely, the AUCROC of the EMSE was 0.777 (95% confidence interval 0.742-0.813). Thus, the probability that a patient who died within 30 days from SE had a higher score than a patient who survived was 83%, indicating good discriminatory power of the nomogram. Conversely, the risk predicted using the EMSE alone was 77%. The nomogram was well calibrated. CONCLUSIONS A nomogram based on EMSE parameters appears superior to the EMSE in predicting the risk of 30-day mortality after SE. The discrimination and calibration of the nomogram shows a better predictive accuracy than the EMSE alone.
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Trinka E, Leitinger M. Management of Status Epilepticus, Refractory Status Epilepticus, and Super-refractory Status Epilepticus. Continuum (Minneap Minn) 2022; 28:559-602. [PMID: 35393970 DOI: 10.1212/con.0000000000001103] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW Status epilepticus is a serious condition caused by disorders and diseases that affect the central nervous system. In status epilepticus, hypersynchronous epileptic activity lasts longer than the usual duration of isolated self-limited seizures (time t1), which causes neuronal damage or alteration of neuronal networks at a certain time point (time t2), depending on the type of and duration of status epilepticus. The successful management of status epilepticus includes both the early termination of seizure activity and the earliest possible identification of a causative etiology, which may require independent acute treatment. In nonconvulsive status epilepticus, patients present only with subtle clinical signs or even without any visible clinical manifestations. In these cases, EEG allows for the assessment of cerebral function and identification of patterns in need of urgent treatment. RECENT FINDINGS In 2015, the International League Against Epilepsy proposed a new definition and classification of status epilepticus, encompassing four axes: symptomatology, etiology, EEG, and age. Various validation studies determined the practical usefulness of EEG criteria to identify nonconvulsive status epilepticus. The American Clinical Neurophysiology Society has incorporated these criteria into their most recent critical care EEG terminology in 2021. Etiology, age, symptomatology, and the metabolic demand associated with an increasing duration of status epilepticus are the most important determinants of prognosis. The consequences of status epilepticus can be visualized in vivo by MRI studies. SUMMARY The current knowledge about status epilepticus allows for a more reliable diagnosis, earlier treatment, and improved cerebral imaging of its consequences. Outcome prediction is a soft tool for estimating the need for intensive care resources.
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Alahmari ZS, Almarie H, Alahmari B, Al Bin Abdullah A, Al-Ayaffi SM, Murugan VM. The Outcome of Status Epilepticus Among Adults in Aseer Region of Saudi Arabia. Cureus 2022; 14:e22880. [PMID: 35399396 PMCID: PMC8980234 DOI: 10.7759/cureus.22880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/06/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Epileptic seizure episodes can vary from brief and nearly undetectable to long periods of vigorous shaking. These episodes can result in physical injuries, occasionally including broken bones. With epilepsy, seizures tend to recur and, as a rule, have no immediate underlying cause. Status epilepticus (SE) is an attack of a seizure lasting for more than five minutes or two or more seizures without the person returning to normal between the attacks. Previous definitions used a 30-minute time limit. This study aimed to assess the clinical outcome of SE among adult patients in the Aseer region. Materials and methods A retrospective record-based cohort study design was conducted, targeting all accessible medical files of adult patients with SE who were admitted to the Aseer central hospital and military hospital from 2010 to 2017. Data were extracted from all complete and accessible files. Records with missing data were excluded. Clinical outcomes for the cases included were assessed and categorized into cases of complete recovery (without sequelae), cases with incomplete recovery, and death. Results The study included 19 adult patients with SE whose ages ranged from seven to 87 years with a mean age of 33.4 ± 22.5 years. Men made up 63.2% of the cases. Infection was the most recorded risk factor among the cases, followed by anti-epileptic drug withdrawal. Only two cases recovered with sequelae, while the remaining 17 cases recovered completely. There were no deaths. Conclusions The study revealed that nearly all cases recovered completely with no complications, particularly men who immediately received IV treatment. Early diagnosis and receiving treatment under careful observation via follow-up are recommended.
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Göl MF, Erdoğan FF, Yetkin MF, Bolattürk ÖF. Clinical findings, etiological factors, and prognosis markers in status epilepticus: a university hospital experience. Neurol Res 2021; 44:371-378. [PMID: 34758704 DOI: 10.1080/01616412.2021.1997009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine the factors affecting mortality and disability in status epilepticus (SE) and to evaluate the prediction ability of the Status Epilepticus Severity Score (STESS) for disability and mortality. MATERIALS AND METHOD The demographic and clinical characteristics, prognosis and prognosis predictors of 72 patients who were diagnosed with SE between 2013 and 2018 were retrospectively evaluated. The STESS was used to predict prognosis, and the modified Rankin scale (mRS) was used to determine the disability at discharge. RESULTS The study population had a mean age of 45.4 ± 20.7, and it was found that mortality was 22.2% and acute symptomatic etiology played a 54.1% role in etiology. Advanced age, refractory SE or super-refractory SE, acute symptomatic etiology, and a history of epilepsy were related to mortality, symptomatic etiology (acute, progressive, remote), a history of hospitalization and epilepsy in intensive care or in other departments other than the neurology department were associated with disability. The sensitivity of STESS in predicting mortality was 100%, specificity was 69%, accuracy was 76.4%, positive predictive value (PPV) was 48.5%, and the negative predictive value (NPV) was 100%. The sensitivity of STESS in predicting mobilization during discharge was 55.6% with a 63.9% specificity and 59.7% accuracy, PPV was 60.6%, and NPV was 59%. CONCLUSION It was observed that STESS strongly predicts a good prognosis; however, it was not found to be useful in predicting motor disability during discharge. Thus, new studies should be conducted to predict and evaluate mobility in SE patients at discharge.
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Affiliation(s)
- Mehmet Fatih Göl
- Department of Neurology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Füsun Ferda Erdoğan
- Department of Neurology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Mehmet Fatih Yetkin
- Department of Neurology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Ömer Faruk Bolattürk
- Clinic of Neurology, T. C. Ministry of Health Kayseri City Education and Research Hospital, Kayseri, Turkey
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Prediction of in-hospital mortality in status epilepticus: Evaluation of four scoring tools in younger and older adult patients. Epilepsy Behav 2021; 114:107572. [PMID: 33268015 DOI: 10.1016/j.yebeh.2020.107572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/19/2020] [Accepted: 10/19/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The goal of this study was to evaluate the predictive capacity of four scoring tools: the Status Epilepticus Severity Score (STESS), the Encephalitis-NCSE-Diazepam resistance-Image abnormalities-Tracheal intubation (END-IT) score, and two variable combinations of the Epidemiology-based Mortality Score in Status Epilepticus (EMSE) in younger and older adult patients with status epilepticus (SE). METHODS We present a retrospective hospital-based analysis with a focus on adult patients with SE at three tertiary care hospitals in the Zhejiang province of China. Data were collected from January 2013 to December 2018. The patients were divided into two groups: younger adult patients (18-64 years old) and older adult patients (≥65 years old). Clinical outcomes (dead or alive) were assessed at hospital discharge. The four scoring tools were used to predict in-hospital mortality in both younger and older adult patients. RESULTS The mortality rate in older adult patients (25.4%) was higher than in younger adult patients (12.9%). Compared with the elderly, the younger adult patients had a higher proportion of encephalitis, while acute cerebrovascular disease and Charlson Complications Index (CCI) were lower. For the younger adult patients, END-IT had the largest area under the curve (AUC) of 0.843 (95% CI, 0.772-0.899), which was higher than the EMSE-EAL value of 0.687 (95% CI, 0.603-0.763, p < 0.05) and EMSE-EAC of 0.646 (95% CI, 0.561-0.725, p < 0.05). For the older adult patients, EMSE-EAL had the largest AUC of 0.843 (95% CI, 0.738-0.919), which was significantly higher than STESS with an AUC of 0.676 (95% CI, 0.554-0.782, p < 0.05). Moreover, the AUC of EMSE-EAL in the elderly was larger than in younger adult patients. The cutoffs in younger adult patients were STESS ≥ 4 (sensitivity 0.444, specificity 0.951), END-IT ≥ 3 (sensitivity 0.833, specificity 0.672), EMSE-EAL ≥ 31 (sensitivity 0.778, specificity 0.566), and EMSE-EAC ≥ 33 (sensitivity 0.833, specificity 0.492). However, the cutoffs in older adult patients were STESS ≥ 5 (sensitivity 0.500, specificity 0.925), END-IT ≥ 2 (sensitivity 0.944, specificity 0.547), EMSE-EAL ≥ 30 (sensitivity 0.944, specificity 0.623), and EMSE-EAC ≥ 31 (sensitivity 0.944, specificity 0.415). CONCLUSION Our results indicated that the STESS, END-IT, EMSE-EAC, and EMSE-EAL scores have excellent capacity to predict in-hospital mortality in both younger and older adult patients with SE. Our study supports the use of END-IT in patients under 65 years of age and suggests that EMSE-EAL is the most suitable scoring tool for patients over 65.
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Ohtomo S, Otsubo H, Arai H, Shimoda Y, Homma Y, Tominaga T. Hyperperfusion in the thalamus on arterial spin labelling indicates non-convulsive status epilepticus. Brain Commun 2020; 3:fcaa223. [PMID: 33501426 PMCID: PMC7811763 DOI: 10.1093/braincomms/fcaa223] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 11/04/2020] [Accepted: 11/24/2020] [Indexed: 12/15/2022] Open
Abstract
Non-convulsive status epilepticus describes the syndrome of unexplained impaired consciousness in critically ill patients. Non-convulsive status epilepticus is very likely to lead to delayed diagnosis and poor outcomes because of the absence of convulsive symptoms. EEG is essential for the diagnosis of non-convulsive status epilepticus to establish the association between periodic discharges and rhythmic delta activity in addition to ictal epileptiform discharges according to the Salzburg criteria. Arterial spin labelling, a type of perfusion MRI, has been applied for rapid and non-invasive evaluation of the ictal state. Ictal cerebral cortical hyperperfusion is the most common finding to demonstrate focal onset seizures. Hyperperfusion of the thalamus on single photon emission computed tomography was found in patients with impaired awareness seizures. We hypothesized that thalamocortical hyperperfusion on arterial spin labelling identifies non-convulsive status epilepticus and such thalamic hyperperfusion specifically associates with periodic/rhythmic discharges producing impaired consciousness without convulsion. We identified 27 patients (17 females; age, 39-91 years) who underwent both arterial spin labelling and EEG within 24 h of suspected non-convulsive status epilepticus. We analysed 28 episodes of suspected non-convulsive status epilepticus and compared hyperperfusion on arterial spin labelling with periodic/rhythmic discharges. We evaluated 21 episodes as a positive diagnosis of non-convulsive status epilepticus according to the Salzburg criteria. We identified periodic discharges in 15 (12 lateralized and 3 bilateral independent) episodes and rhythmic delta activity in 13 (10 lateralized, 1 bilateral independent and 2 generalized) episodes. Arterial spin labelling showed thalamic hyperperfusion in 16 (11 unilateral and 5 bilateral) episodes and cerebral cortical hyperperfusion in 24 (20 unilateral and 4 bilateral) episodes. Thalamic hyperperfusion was significantly associated with non-convulsive status epilepticus (P = 0.0007; sensitivity, 76.2%; specificity, 100%), periodic discharges (P < 0.0001; 93.3%; 84.6%), and rhythmic delta activity (P = 0.0006; 92.3%; 73.3%). Cerebral cortical hyperperfusion was significantly associated with non-convulsive status epilepticus (P = 0.0017; 100%; 57.1%) and periodic discharges (P = 0.0349; 100%; 30.8%), but not with rhythmic delta activity. Thalamocortical hyperperfusion could be a new biomarker of non-convulsive status epilepticus according to the Salzburg criteria in critically ill patients. Specific thalamic hyperexcitability might modulate the periodic discharges and rhythmic delta activity associated with non-convulsive status epilepticus. Impaired consciousness without convulsions could be caused by predominant thalamic hyperperfusion together with cortical hyperperfusion but without ictal epileptiform discharges.
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Affiliation(s)
- Satoru Ohtomo
- Department of Neurosurgery, South Miyagi Medical Center, Shibata-gun, Miyagi, Japan
| | - Hiroshi Otsubo
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hiroaki Arai
- Department of Neurosurgery, South Miyagi Medical Center, Shibata-gun, Miyagi, Japan
| | - Yoshiteru Shimoda
- Department of Neurosurgery, South Miyagi Medical Center, Shibata-gun, Miyagi, Japan
| | - Yoichiro Homma
- Department of General Internal Medicine, Seirei-Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Assessing the Risk/Benefit at Status Epilepticus Onset: The Prognostic Scores. J Clin Neurophysiol 2020; 37:381-384. [DOI: 10.1097/wnp.0000000000000653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Jiang Y, Yang Y, Feng F, Zhang Y, Wang XH, Ni FL, Hou Q, Zhang LP. Improving the ability to predict hospital mortality among adults by combining two status epilepticus outcome scoring tools. Epilepsy Behav 2020; 110:107149. [PMID: 32480304 DOI: 10.1016/j.yebeh.2020.107149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/26/2020] [Accepted: 04/26/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The goal of this study was to compare the predictive ability of the Status Epilepticus Severity Score (STESS), the Encephalitis-nonconvulsive status epilepticus (NCSE)-Diazepam resistance-Image abnormalities-Tracheal intubation (END-IT), and the combination of these two scoring tools to predict mortality among inhospital patients with status epilepticus (SE). METHODS A retrospective analysis was conducted of adult patients with SE who were admitted to the neurology department, the emergency department, and the intensive care unit from January 2013 to December 2017. The patients were divided into two groups: survivors and nonsurvivors. The STESS data were obtained when the patient arrived at the hospital, and the END-IT data were collected 24 h after patients were initially treated in the hospital. The ability of the scoring tools to predict death in patients with SE, alone or in combination, was evaluated. RESULTS A total of 123 patients with SE were included in the study, of which 22 died, for a mortality rate of 17.9%. The STESS and END-IT scores of nonsurvivors were both significantly higher than those of survivors (median STESS 4 vs. 2, p = 0.003; median END-IT 3 vs. 1, p < 0.001). The area under the receiver operating characteristic curve (AUC) was 0.698 for the STESS and 0.852 for the END-IT, and the cutoff values were 4 and 3, respectively. The AUC of the END-IT with the optimal cutoff value was larger than that of the STESS (p = 0.024). The sensitivity and specificity of combining the STESS and END-IT by the serial method (STESS ≥ 4∩END-IT ≥ 3) were 0.50 and 0.95, respectively, and the specificity was significantly higher than the STESS or END-IT (both p's < 0.001). The sensitivity and specificity of combining the STESS and END-IT by the parallel method (STESS ≥ 4⋃END-IT ≥ 3) were 0.91 and 0.53, respectively, and the sensitivity was higher than the STESS was (p = 0.016). CONCLUSION Our results indicated that the combined score of the STESS and END-IT systems was a better predictor of survival of patients with SE than the scores of either the STESS system or the END-IT system alone and that combining the scores may be considered to be a new method for early identification of patients for both good and bad outcomes.
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Affiliation(s)
- Yan Jiang
- Department of Neurology, The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yi Yang
- Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fei Feng
- Department of Gerontology, Hangzhou First People's Hospital, Hangzhou, China
| | - Ying Zhang
- Clinical Evaluation Analysis Center, The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiao-Hang Wang
- Department of Neurology, The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Fei-Lin Ni
- Department of Neurology, The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Qun Hou
- Department of Neurology, The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Li-Ping Zhang
- Department of Neurology, The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China.
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Alkhachroum A, Der-Nigoghossian CA, Rubinos C, Claassen J. Markers in Status Epilepticus Prognosis. J Clin Neurophysiol 2020; 37:422-428. [PMID: 32890064 PMCID: PMC7864547 DOI: 10.1097/wnp.0000000000000761] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Status epilepticus (SE) is a neurologic emergency with high morbidity and mortality. The assessment of a patient's prognosis is crucial in making treatment decisions. In this review, we discuss various markers that have been used to prognosticate SE in terms of recurrence, mortality, and functional outcome. These markers include demographic, clinical, electrophysiological, biochemical, and structural data. The heterogeneity of SE etiology and semiology renders development of prognostic markers challenging. Currently, prognostication in SE is limited to a few clinical scores. Future research should integrate clinical, genetic and epigenetic, metabolic, inflammatory, and structural biomarkers into prognostication models to approach "personalized medicine" in prognostication of outcomes after SE.
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Affiliation(s)
- Ayham Alkhachroum
- Department of Neurology, Columbia University, New York, NY, USA
- Department of Neurology, University of Miami, Miami, FL, USA
| | | | - Clio Rubinos
- Department of Neurology, Columbia University, New York, NY, USA
| | - Jan Claassen
- Department of Neurology, Columbia University, New York, NY, USA
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Sato K, Arai N, Takeuchi S. Status epilepticus severity score as a predictor for the length of stay at hospital for acute-phase treatment in convulsive status epilepticus. J Clin Neurosci 2020; 75:128-133. [PMID: 32178991 DOI: 10.1016/j.jocn.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/25/2020] [Accepted: 03/02/2020] [Indexed: 12/22/2022]
Abstract
To date, hospital length of stay (LOS) determinants for convulsive status epilepticus's (CSE) acute-phase treatment have not been sufficiently investigated, as opposed to those for status epilepticus's (SE) outcome predictors, such as status epilepticus severity score (STESS). Here, we aimed at assessing the significance of STESS in the LOS in patients with CSE. We retrospectively reviewed consecutive adult patients with CSE who were transported to the emergency department of our urban tertiary care hospital in Tokyo, Japan. The study period was from August 2010 to September 2015. The primary endpoint was the LOS of patients with CSE who were directly discharged after acute-phase treatment, and survival analysis for LOS until discharge was conducted. As a result, among 132 eligible patients with CSE admitted to our hospital, 96 (72.7%) were directly discharged with a median LOS of 10 days (IQR: 4-19 days). CSE patients with severe seizures, represented by higher STESS (≥3), had a significantly longer LOS after adjustments with multiple covariates (p = 0.016, in restricted mean survival time analysis). Additionally, prediction for the binomial longer/shorter LOS achieved better performance when STESS was incorporated into the prediction model. Our findings indicate that STESS can also be used as a rough predictor of longer LOS at index admission of patients with CSE.
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Affiliation(s)
- Kenichiro Sato
- Department of Neurology, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Noritoshi Arai
- Department of Neurology, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan.
| | - Sousuke Takeuchi
- Department of Neurology, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
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Tatlidil I, Ture HS, Akhan G. Factors affecting mortality of refractory status epilepticus. Acta Neurol Scand 2020; 141:123-131. [PMID: 31550052 DOI: 10.1111/ane.13173] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/23/2019] [Accepted: 09/21/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to determine the factors affecting the mortality of refractory status epilepticus (RSE) in comparison with non-refractory status epilepticus (non-RSE). MATERIAL-METHOD Included in this retrospective study were 109 status epilepticus cases who were hospitalized in the neurological intensive care unit Katip Celebi University. Fifty-two were RSE and 57 were non-RSE. All clinical data were gathered from the hospital archives. Factors which may cause mortality were categorized for statistical analysis. RESULTS While elderly age, continuous clinical seizure activity, absence of former seizure, infection, prolonged stay of ICU, anesthesia, and cardiac comorbidity were significantly related to mortality in the RSE subgroup, potentially fatal accompanying diseases were significantly related to mortality in the non-RSE subgroup. No significant relationship was found between mortality and refractoriness. Multivariate analysis revealed that a Glasgow Coma Score (GCS) at presentation of 8 or lower was the independent predictor of mortality both in the general SE population (P = .017) and in the RSE subgroup (P = .007). Intubation (P = .011) and hypotension (P = .011) were the other independent predictors of mortality in the general SE population. No independent predictor of mortality was detected in the non-RSE subgroup. DISCUSSION/CONCLUSION Intubation, hypotension, and a low GCS at presentation could be the main factors which could alert clinicians of an increased risk of mortality in SE patients. Although non-RSE and RSE had similar rates of mortality in the ICU, the mortality-related factors of SE vary in the RSE and the non-RSE subgroups.
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Affiliation(s)
- Isil Tatlidil
- Department of Neurology Malatya Research and Training Hospital Malatya Turkey
| | - Hatice S. Ture
- Department of Neurology Katip Celebi University İzmir Turkey
| | - Galip Akhan
- Department of Neurology Katip Celebi University İzmir Turkey
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El-Tamawy MS, Amer H, Kishk NA, Nawito AM, Basheer MA, Alieldin N, Magdy R, Othman AS. External validation of STESS and EMSE as outcome prediction scores in an Egyptian cohort with status epilepticus. Epilepsy Behav 2020; 102:106686. [PMID: 31760201 DOI: 10.1016/j.yebeh.2019.106686] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/04/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE There is a lack of data concerning the performance of the outcome prediction scores in patients with status epilepticus (SE) in developing countries. The aim of this study was to compare the predictive performances of the status epilepticus severity score (STESS) and the epidemiology-based mortality score in status epilepticus (EMSE) and adaptation of such scoring system to be compatible with the nature of society. METHOD This is a prospective study, conducted in Egypt from the period of January 2017 to June 2018. The main outcome measure was survival versus death, on hospital discharge. The cutoff point with the best sensitivity and specificity to predict mortality was determined through a receiver operating characteristic (ROC) curve. RESULTS Among the 144 patients with SE with a mean age of 39.3 ± 19.5 years recruited into the study, 38 patients (26.3%) died in the hospital with the survival of 99 patients while 7 patients (4.9%) were referred to other centers with an unknown outcome. Although EMSE had a bit larger area under the curve (AUC) (0.846) than STESS-3 (AUC 0.824), STESS-3 had the best performance as in-hospital death prediction score as it has a higher negative predictive value (94.6%) than that of EMSE (90.9%) in order not to miss high-risk patients. CONCLUSION In the Egyptian population, STESS and EMSE are useful tools in predicting mortality outcome of SE. The STESS performed significantly better than EMSEE combinations as a mortality prediction score.
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Affiliation(s)
- Mohamed S El-Tamawy
- Department of Neurology, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hanan Amer
- Department of Neurology, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nirmeen A Kishk
- Department of Neurology, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amani M Nawito
- Department of Neurophysiology, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mye A Basheer
- Department of Neurophysiology, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nelly Alieldin
- Department of Cancer Epidemiology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Rehab Magdy
- Department of Neurology, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Alshimaa S Othman
- Department of Neurology, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
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Verma A, K K, Kumar A. Clinical profile and comparison of scoring tools for the prediction of in-hospital mortality in convulsive status epilepticus in elderly. Epilepsy Behav 2019; 101:106571. [PMID: 31675605 DOI: 10.1016/j.yebeh.2019.106571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 09/12/2019] [Accepted: 09/12/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE The present study was aimed to study the clinical profile, etiologies, and outcome of convulsive status epilepticus (CSE) in elderly patients and also to compare the predictive accuracy of the Status Epilepticus Severity Score (STESS) and Epidemiology-based Mortality Score in Status Epilepticus - etiology, age, level of consciousness (EMSE-EAL) score for in-hospital mortality. METHODS Eighty-five elderly patients (≥60 years of age) with a diagnosis of CSE were consecutively enrolled. The distinction between the score performances was determined by comparing the means area under the receiver operating characteristic curve (AUC). RESULTS The mean age of respondents was 66.3 ± 7.4 years; the most common etiology of CSE was stroke (acute and remote symptomatic) in 48.2% of cases. In-hospital mortality was 16.5% in our series, and on multivariate analysis, variables significantly related with mortality were lack of response to first-line drugs (odds ratio (OR) = 43.05, 95% confidence interval (CI) = 4.7-386.8; p = .001) and higher EMSE-EAL score (OR = 0.08, 95% CI = 0.015-0.47; p = .005). On comparison, STESS with the cutoff value of ≥3 has AUC of 0.678 (95%CI = 0.54-0.81), whereas ESME-EAL with the cutoff value of ≥40 showed AUC of 0.901 (95% CI = 0.83-0.97). CONCLUSIONS Most frequent cause of CSE in elderly in our series was stroke and was also associated with high mortality. For the prediction of in-hospital mortality in elderly, EMSE-EAL-40 score is superior to STESS-3, which can be easily applied in resource-poor sectors with limited diagnostic facilities especially where continuous video-electroencephalogram (EEG) monitoring is unavailable.
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Affiliation(s)
- Archana Verma
- Department of Neurology, UP University of Medical Sciences, Saifai, Etawah 206301, U.P., India.
| | - Kiran K
- Department of Community Medicine, UP University of Medical Sciences, Saifai, Etawah 206301, U.P., India
| | - Alok Kumar
- Forensic Medicine & Toxicology, UP University of Medical Sciences, Saifai, Etawah 206130, U.P., India
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Lin CH, Ho CJ, Lu YT, Shih FY, Chuang YC, Tsai MH. Predicting the Functional Outcome of Adult Patients with Status Epilepticus. J Clin Med 2019; 8:jcm8070992. [PMID: 31288449 PMCID: PMC6678186 DOI: 10.3390/jcm8070992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/02/2019] [Accepted: 07/04/2019] [Indexed: 11/16/2022] Open
Abstract
Patients that survive status epilepticus (SE) may suffer from neurological and cognitive deficits that cause severe disabilities. An effective scoring system for functional outcome prediction may help the clinician in making treatment decisions for SE patients. Three scoring systems, namely the Status Epilepticus Severity Score (STESS), the Epidemiology-Based Mortality Score in Status Epilepticus (EMSE), and the Encephalitis-Nonconvulsive Status Epilepticus-Diazepam Resistance-Image Abnormalities-Tracheal Intubation (END-IT), have been developed in the past decade to predict the outcomes of patients with SE. Our study aimed at evaluating the effectiveness of these scores in predicting the function outcomes both at and after discharge in SE patients. We retrospectively reviewed the clinical data of 55 patients admitted to our neurological intensive care unit between January 2017 and December 2017. The clinical outcomes at discharge and at last follow-up were graded using the modified Rankin Scale. Our research indicated that STESS was the most sensitive and EMSE was the most specific predictive scoring method for SE outcome prediction. On the other hand, END-IT predicted functional outcomes in SE patients poorly. We concluded that STESS and EMSE can accurately predict the functional outcomes in SE patients both at discharge and the follow-up period.
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Affiliation(s)
- Chih-Hsiang Lin
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 83301, Taiwan
| | - Chen-Jui Ho
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 83301, Taiwan
| | - Yan-Ting Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 83301, Taiwan
| | - Fu-Yuan Shih
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 83301, Taiwan
| | - Yao-Chung Chuang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 83301, Taiwan
- Department of Biological Science, National Sun Yet-Sen University, Kaohsiung City 80424, Taiwan
| | - Meng-Han Tsai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 83301, Taiwan.
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan.
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Dani R, Sodani A, Telang K, Nigam R. Determinants of Outcome in Convulsive Status Epilepticus in Adults: An Ambispective Study from Central India. Ann Indian Acad Neurol 2019; 22:84-90. [PMID: 30692765 PMCID: PMC6327706 DOI: 10.4103/aian.aian_466_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The determinants of the outcome in adult convulsive status epilepticus(CSE), also the implication of the value of mean arterial blood pressure (MAP), and random blood sugar at admission on the outcome are not clear. OBJECTIVES The objective of this study is to look for the determinants of unfavorable outcome in CSE. MATERIALS AND METHODS Ambispectively gathered data from 55 patients, treated consecutively with identical protocol during January 2010-December 2016, were analyzed. The demographic and clinical variables were identified and correlated with outcome in each individual. RESULTS There were 65.45% males and 34.55% females. Favorable outcome (conscious and discharged) was seen in 63.6%, unfavorable (death 14.5%, absent cortical functions 10.9%, and inability to wean-off anesthetic agents 10.9%). The parameters associated with unfavorable outcome were female gender (odds ratio [OR]: 1.45), MAP ≤80 mmHg (OR: 2.57), time to first medical attention >5 h (OR: 127.8), and time to control clinical seizures >3.5 h (OR: 7.87). Almost 44.2% of patients with SE severity score >2 had unfavorable outcome (sensitivity 75% and specificity 45.7%). New scoring system, the CSE outcome score (CSEOS, developed by combining the predictors associated with higher odds of poor outcome), predicted the poor outcome with the sensitivity and specificity of 90% and 54.29%, respectively. DISCUSSION AND CONCLUSION Low MAP and delay of >3.5 h in treatment initiation or seizure control are the key determinants of poor outcome in CSE. With the incorporation of CSEOS, we believe that our findings can be helpful in the process of clinical decision-making and prognostication of patients with CSE.
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Affiliation(s)
- Raunak Dani
- Department of Neurology, Sri Aurobindo Medical College and P.G. Institute, Indore, Madhya Pradesh, India
| | - Ajoy Sodani
- Department of Neurology, Sri Aurobindo Medical College and P.G. Institute, Indore, Madhya Pradesh, India
| | - Kapil Telang
- Department of Neurology, Sri Aurobindo Medical College and P.G. Institute, Indore, Madhya Pradesh, India
| | - Richa Nigam
- Department of Neurology, Sri Aurobindo Medical College and P.G. Institute, Indore, Madhya Pradesh, India
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Leitinger M, Trinka E, Giovannini G, Zimmermann G, Florea C, Rohracher A, Kalss G, Neuray C, Kreidenhuber R, Höfler J, Kuchukhidze G, Granbichler C, Dobesberger J, Novak HF, Pilz G, Meletti S, Siebert U. Epidemiology of status epilepticus in adults: A population-based study on incidence, causes, and outcomes. Epilepsia 2018; 60:53-62. [PMID: 30478910 PMCID: PMC7380005 DOI: 10.1111/epi.14607] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 11/28/2022]
Abstract
Objective In 2015, the International League Against Epilepsy (ILAE) proposed a new definition of status epilepticus (SE): 5 minutes of ongoing seizure activity to diagnose convulsive SE (CSE, ie, bilateral tonic–clonic SE) and 10 minutes for focal SE and absence SE, rather than the earlier criterion of 30 minutes. Based on semiology, several types of SE with prominent motor phenomena at any time (including CSE) were distinguished from those without (ie, nonconvulsive SE, NCSE). We present the first population‐based incidence study applying the new 2015 ILAE definition and classification of SE and report the impact of the evolution of semiology and level of consciousness (LOC) on outcome. Methods We conducted a retrospective population‐based incidence study of all adult patients with SE residing in the city of Salzburg between January 2011 and December 2015. Patients with hypoxic encephalopathy were excluded. SE was defined and classified according to the ILAE 2015. Results We identified 221 patients with a median age of 69 years (range 20‐99 years). The age‐ and sex‐adjusted incidence of a first episode of SE, NCSE, and SE with prominent motor phenomena (including CSE) was 36.1 (95% confidence interval [CI] 26.2‐48.5), 12.1 (95% CI 6.8‐20.0), and 24.0 (95% CI 16.0‐34.5; including CSE 15.8 [95% CI 9.4‐24.8]) per 100 000 adults per year, respectively. None of the patients whose SE ended with or consisted of only bilateral tonic–clonic activity died. In all other clinical presentations, case fatality was lower in awake patients (8.2%) compared with patients with impaired consciousness (33%). Significance This first population‐based study using the ILAE 2015 definition and classification of SE found an increase of incidence of 10% compared to previous definitions. We also provide epidemiologic evidence that different patterns of status evolution and LOCs have strong prognostic implications.
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Affiliation(s)
- Markus Leitinger
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria.,Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Giada Giovannini
- Unit of Neurology, OCSAE Hospital, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Georg Zimmermann
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria.,Department of Mathematics, Paris Lodron University, Salzburg, Austria
| | - Cristina Florea
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria
| | - Alexandra Rohracher
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria
| | - Gudrun Kalss
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria
| | - Caroline Neuray
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria
| | - Rudolf Kreidenhuber
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria
| | - Julia Höfler
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria
| | - Claudia Granbichler
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Judith Dobesberger
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria
| | - Helmut F Novak
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria
| | - Georg Pilz
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria
| | - Stefano Meletti
- Unit of Neurology, OCSAE Hospital, Azienda Ospedaliera Universitaria, Modena, Italy.,Department of Biomedical, Metabolic, and Neural Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.,Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Institute for Technology Assessment and Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
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Tiamkao S, Buranakul N, Saybungkla P, Sirikarn P, Sawanyawisuth K. Risk score predictive of mortality in status epilepticus according to a national database. Epilepsia 2018; 59 Suppl 2:182-187. [PMID: 30159871 DOI: 10.1111/epi.14489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2018] [Indexed: 11/28/2022]
Abstract
Status epilepticus (SE) is a serious neurologic condition with high morbidity and mortality rates. This study aimed to develop and validate a risk score that is predictive of mortality in patients with SE using clinical factors without electrocardiography. The inclusion criteria of this study were all patients diagnosed with SE and treated between 2005 and 2015. We retrospectively searched for eligible patients using the International Classification of Diseases, Tenth Revision (ICD-10) code for SE (G41) in the national Universal Health Coverage database. The outcome was death at discharge or within 30 days after discharge. Factors-associated death was analyzed using stepwise logistic regression analysis. Risk scores were developed based on the final logistic regression model. The final model was also validated. There were 10 924 patients used for model development and 10 808 used for model validation. The formula to determine the risk score for SE mortality was 5 × shock + 4 × age over 60 years old + 3.5 × heart diseases + 3 × acute renal failure + 3 × septicemia + 2.5 × central nervous system infection + 2.5 × age 41-60 years old + 2 × cancer + 2 × chronic renal failure + 1.5 × age 21-40 years old + 1 × pneumonia + 1 × respiratory failure + 1 × anemia. The risk scores of greater than 4 indicated risk for mortality with a sensitivity of 78.20% and specificity of 75.38%. The area under the receiver-operating characteristic (ROC) curve for death in the final model was 83.59%. The area under the ROC curve for the model validation group was 83.52%. SE patients who had a risk score of 4 or more were at high risk for death. Physicians should be aware of the high mortality rate in these particular patients.
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Affiliation(s)
- Somsak Tiamkao
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Nattakarn Buranakul
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Pawinee Saybungkla
- Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand.,Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Prapassara Sirikarn
- Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Doctor of Philosophy Program in Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Kittisak Sawanyawisuth
- Department of Medicine and Ambulatory Medicine Research Group, Faculty of Medicine, Khon Kean University, Khon Kaen, Thailand
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- Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand
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Yuan F, Gao Q, Jiang W. Prognostic scores in status epilepticus-a critical appraisal. Epilepsia 2018; 59 Suppl 2:170-175. [PMID: 30159870 DOI: 10.1111/epi.14483] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2017] [Indexed: 11/30/2022]
Abstract
Currently, there are 4 published scales evaluating status epilepticus (SE) prognosis: the Status Epilepticus Severity Score (STESS), the Epidemiology-based Mortality score in Status Epilepticus (EMSE), the modified STESS (mSTESS), and the Encephalitis Nonconvulsive Status Epilepticus Diazepam Resistence Imaging Tracheal Intubation (END-IT) score. The first prognostic score published for SE, the STESS, is a simple and practical scale that evaluates patient prognosis upon admission and is used widely to predict the outcome and stratify patients. Another scale, which was developed based on large epidemiologic studies, the EMSE, is more easily adapted to different regions around the world when assessing individual risk and stratifying patients in interventional studies. The mSTESS was created by adding the modified Rankin Scale (mRS) to the STESS, which decreases the ceiling effect and increases the mortality prediction capabilities of the STESS. The END-IT is the only prognostic scale assessing functional outcome and is comprehensively simple and satisfyingly accurate. Evaluating the limitations of each of these scales aids in the exploration and advancement of SE prognostic scales, thereby facilitating better clinical interventions and scientific research.
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Affiliation(s)
- Fang Yuan
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Qiong Gao
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Wen Jiang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Rivero Rodríguez D, Scherle Matamoros C, Sam K, DiCapua Sacoto D, Samaniego NM, Pernas Y. Evaluation of STESS, mRSTESS, and EMSE to Predict High Disability and Mortality at Hospital Discharge in Ecuadorian Patients with Status Epilepticus. Neurocrit Care 2018; 29:413-418. [PMID: 29949007 DOI: 10.1007/s12028-018-0549-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adequate identification of the severity of status epilepticus (SE) contributes to individualized treatment. The scales most widely used for this purpose are: Status Epilepticus Severity Score (STESS), Epidemiology-Based Mortality Score in Status Epilepticus (EMSE) and modified Rankin Scale STESS (mRSTESS). The aim of this study was to evaluate the performance of the STESS, EMSE and mRSTESS scales to predict high disability and hospital mortality at discharge (HD/HM). METHODS A prospective study was conducted in which total of 41 patients were registered from November 2015 to January 2018 at Eugenio Espejo Hospital. Clinical variables such as age, sex, clinical status at the beginning of the SE, initial symptom of SE, as well as the STESS, mRSTESS and EMSE variant scales were studied at the time of the diagnosis of SE. RESULTS A total of 41 patients were evaluated, of which 8 (19.5%) had HD at hospital discharge and died 13 (31.7%) during their care. The area under the receiver operating characteristic curve to predict HD/HM was 0.71 (95% CI (confidence interval) 0.55-0.87), 0.81 (95% CI 0.67-0.94), 0.89 (95% CI 0.79-0.99), 0.90 (95% CI 0.80-1.0), 0.89 (95% CI 0.78-0.99) for the STESS, mRSTESS, EMSE-EAC (etiology, age, comorbidities), EMSE-EACEG (etiology, age, comorbidities, electroencephalography) and EMSE-ECLEG (etiology, age, level of consciousness at pre-treatment, electroencephalography), variants of EMSE, respectively. The binary logistic regression demonstrated how the following cut-off points were determined: STESS OR (odd ratio) 4.80 (p = 0.02), mRSTESS OR 7.89 (p = 0.00), EMSE-EAC OR 22.16 (p = 0.00), EMSE-ECLEG OR 18.00 (p = 0.00), EMSE-EACEG OR 14 (p = 0.00). CONCLUSIONS All of the evaluated scales (STESS, mRSTESS, and EMSE) were shown to be useful in predicting HD/HM. EMSE was observed to be the most effective of the scales, with relative similarities among the variants.
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Affiliation(s)
- Dannys Rivero Rodríguez
- Neurology Department, Eugenio Espejo Hospital, Gran Colombia Ave., 170136, Quito, Pichincha, Ecuador.
| | - Claudio Scherle Matamoros
- Neurology Department, Eugenio Espejo Hospital, Gran Colombia Ave., 170136, Quito, Pichincha, Ecuador
- San Francisco University of Quito (USFQ), Quito, Ecuador
| | - Kimberly Sam
- San Francisco University of Quito (USFQ), Quito, Ecuador
| | - Daniela DiCapua Sacoto
- Neurology Department, Eugenio Espejo Hospital, Gran Colombia Ave., 170136, Quito, Pichincha, Ecuador
- San Francisco University of Quito (USFQ), Quito, Ecuador
| | | | - Yanelis Pernas
- Internal Medicine Department, Andrade Marin Hospital, Quito, Ecuador
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The electroclinical spectrum, etiologies, treatment and outcome of nonconvulsive status epilepticus in the elderly. Epilepsy Behav 2018; 79:53-57. [PMID: 29253676 DOI: 10.1016/j.yebeh.2017.10.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/24/2017] [Accepted: 10/27/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Nonconvulsive status epilepticus (NCSE) in the elderly is particularly difficult to diagnose, mainly due to subtle clinical manifestations and associated comorbidities. The recently validated electroencephalography (EEG) diagnostic criteria for NCSE and the proposed operational classification of status epilepticus provide tools that can allow an earlier diagnosis and better management of NCSE in this age group, possibly contributing to reduce its high mortality. MATERIAL AND METHODS we used these tools to identify and characterize a cohort of elderly (>60year-old) patients admitted at our institution in a 3-year period; the video-EEG and clinical files of the patients fulfilling EEG diagnostic criteria for NCSE were reviewed, being in this study described their electroclinical spectrum, etiologies, treatment, inhospital mortality, and status epilepticus severity score (STESS). RESULTS Fourty patients (23 women; mean age 76.6years) were identified. Although dyscognitive NCSE associated with >2.5Hz of epileptiform discharges (ED) was the most frequent electroclinical phenotype, this was quite heterogeneous, ranging from patients with aura continua to patients in coma, associated with frequent ED or rhythmic slow activities. Acute symptomatic (45%) and multifactorial (27.5%) etiologies were the most common, and associated with the worst prognosis. There was a trend to use newer antiepileptic drugs in the early steps of NCSE treatment. The inhospital mortality was high (22.5%) and predicted by STESS scores ≥3. CONCLUSION In the elderly, NCSE has heterogeneous electroclinical phenotypes and etiologies. In spite of the treatment limitations conditioned by the comorbidities, more aggressive treatments could be justified to reduce mortality in patients with high STESS scores.
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Reindl C, Knappe RU, Sprügel MI, Sembill JA, Mueller TM, Hamer HM, Huttner HB, Madžar D. Comparison of scoring tools for the prediction of in-hospital mortality in status epilepticus. Seizure 2018; 56:92-97. [PMID: 29455141 DOI: 10.1016/j.seizure.2018.01.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Several scoring tools have been developed for the prognostication of outcome after status epilepticus (SE). In this study, we compared the performances of STESS (Status Epilepticus Severity Score), mSTESS (modified STESS), EMSE-EAL (Epidemiology-based Mortality Score in Status Epilepticus- Etiology, Age, Level of Consciousness) and END-IT (Encephalitis-NCSE-Diazepam resistance-Image abnormalities-Tracheal intubation) in predicting in-hospital mortality after SE. METHOD Data collected retrospectively from a cohort of 287 patients with SE were used to calculate STESS, mSTESS, EMSE-EAL, and END-IT scores. The differences between the scores' performances were determined by means of area under the ROC curve (AUC) comparisons and McNemar testing. RESULTS The in-hospital mortality rate was 11.8%. The AUC of STESS (0.628; 95% confidence interval (CI), 0.529-0.727) was similar to that of mSTESS (0.620; 95% CI, 0.510-0.731), EMSE-EAL (0.556; 95% CI, 0.446-0.665), and END-IT (0.659; 95% CI, 0.550-0.768; p > .05 for each comparison) in predicting in-hospital mortality. STESS with a cutoff of 3 was found to have lowest specificity and number of correctly classified episodes. EMSE-EAL with a cutoff at 40 had highest specificity and showed a trend towards more correctly classified episodes while sensitivity tended to be low. END-IT with a cutoff of 3 had the most balanced sensitivity-specificity ratio. CONCLUSIONS EMSE-EAL is as easy to calculate as STESS and tended towards higher diagnostic accuracy. Adding information on premorbid functional status to STESS did not enhance outcome prediction. END-IT was not superior to other scores in prediction of in-hospital mortality despite including information of diagnostic work-up and response to initial treatment.
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Affiliation(s)
- Caroline Reindl
- Department of Neurology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Ruben U Knappe
- Department of Neurology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Maximilian I Sprügel
- Department of Neurology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Jochen A Sembill
- Department of Neurology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Tamara M Mueller
- Department of Neurology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Hajo M Hamer
- Department of Neurology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Hagen B Huttner
- Department of Neurology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Dominik Madžar
- Department of Neurology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
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Hommady RH, Alrifai MT, Mubayrik OK, Alayed RS, Alsemari MA, Arumayyan A, Altuwaijri W, Baarmah D. Retrospective review of pediatric status epilepticus in 116 Saudi patients: predictors of outcome. Ann Saudi Med 2017; 37:455-460. [PMID: 29229894 PMCID: PMC6074125 DOI: 10.5144/0256-4947.2017.455] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Status epilepticus (SE) is a common, life-threatening condition. Multiple factors are used to predict its outcome and evaluate its risks, and there have been only a few studies in Saudi Arabia. OBJECTIVES Investigate predictors of SE outcome. DESIGN Retrospective chart review study. SETTING Tertiary center, Riyadh. PATIENTS AND METHODS We reviewed all pediatric cases (age 14 years or younger) of SE admitted between January 2005 and December 2015, collecting data on age, sex, date of birth, developmental status, pre-existing neurological diseases, SE etiology, Glasgow Outcome Scale (GOS) scores, and electroencephalogram (EEG) findings. The outcome was categorized as poor based on any decrease in baseline GOS score or moderate-to-severe developmental delay in young children; otherwise outcome was considered good. MAIN OUTCOME MEASURE Outcome of SE. RESULTS One hundred and sixteen patients (54% boys) with ages from 1 month to 10 years were included in the analysis. Fifty-five (47.4%) had a poor outcome. The overall mortality rate related to SE was 2.6%. Four patients had an SE duration of more than 24 hours. Univariate and multivariate analysis revealed that poor outcome was related to symptomatic SE etiology and a history of epilepsy. Age, sex, SE duration, and EEG findings were not predictors of poor outcome. CONCLUSION Pediatric status epilepticus is highly associated with neurological morbidity. The main pre.dictor of outcome is underlying symptomatic etiology of SE and to a lesser degree the presence of a history of epilepsy. Duration does not seem to play a major role. LIMITATIONS The main limitation is the retrospective chart review nature of the study with possible bias.
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Affiliation(s)
| | - Muhammad Talal Alrifai
- Dr. Muhammad Talal Alrifai, Department of Pediatrics Neurology,, King Abdulaziz Medical City,, King Abdullah Specialized Children's Hospital,, Riyadh, Saudi Arabia, T: +966506404163, , ORCID ID: https://orcid.org/0000-0002-5203-438X
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Topiramate in the Treatment of Generalized Convulsive Status Epilepticus in Adults: A Systematic Review with Individual Patient Data Analysis. Drugs 2017; 77:67-74. [PMID: 28004305 PMCID: PMC5216088 DOI: 10.1007/s40265-016-0672-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Generalized convulsive status epilepticus (GCSE) is a medical emergency associated with high morbidity and mortality that requires prompt medical intervention. Topiramate (TPM) is an antiepileptic drug effective against a broad spectrum of seizure types, and has been proposed as a possible therapeutic option for super-refractory status epilepticus (SRSE), the most severe form of GCSE. AIM This review aimed to evaluate the role of TPM in GCSE, including SRSE. METHODS MEDLINE, CENTRAL, ClinicalTrials.gov, LILACS, Google Scholar, and Opengrey.eu were systematically searched. We compared: (1) patients who did and who did not receive TPM as their last drug; (2) patients receiving TPM as the last drug and achieving SE control and patients receiving TPM as the last drug but without termination of SE. RESULTS The literature search yielded 1164 results, with individual data available for 35 patients (six with SRSE) from four studies. SE was controlled in 68.6% of patients receiving TPM either as the last drug (20) or not (15), and in 14 of the 20 patients receiving TPM as the last drug (70%). Only six patients received TPM for SRSE; in five of them, TPM was administered as the last drug with resolution of SE in four. When comparing patients who did and did not receive TPM as the last drug, no statistically significant difference was found for any of the variables considered; similarly, no difference was found comparing patients receiving TPM as the last drug and achieving SE control with those receiving TPM as the last drug but without termination of SE. CONCLUSIONS The lack of a statistically significant difference is likely to be due to the small sample size. In only a few patients was TPM used for SRSE. There is an unmet need for high-quality studies to evaluate the role of TPM in GCSE.
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Mortality, morbidity and refractoriness prediction in status epilepticus: Comparison of STESS and EMSE scores. Seizure 2017; 46:31-37. [DOI: 10.1016/j.seizure.2017.01.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/29/2017] [Accepted: 01/30/2017] [Indexed: 11/23/2022] Open
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Huang Q, Wu Y, Qin R, Wei X, Ma M. Clinical characteristics and outcomes between children and adults with anti-N-Methyl-D-Aspartate receptor encephalitis. J Neurol 2016; 263:2446-2455. [PMID: 27632180 DOI: 10.1007/s00415-016-8282-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 08/31/2016] [Accepted: 09/01/2016] [Indexed: 01/17/2023]
Abstract
Anti-N-Methyl-D-Aspartate receptor (NMDAR) encephalitis is an acute neurological disorder affecting children and adults. We aimed to compare the clinical characteristics, treatments, and outcomes between children and adults with anti-NMDAR encephalitis and to assess the probable risk factors. In this observational study, patients who tested positive for anti-NMDAR antibody in the cerebrospinal fluid were enrolled. The patients were divided into children and adults group on the basis of age (whether <16 or not). Clinical outcomes were assessed at onset, 1, 3, 6, 9, and 12 months after the patients received treatment and were scored based on whether they required hospitalization and intensive care. A total of 15 children and 14 adults were examined. The adults more likely manifested status epilepticus, central hypoventilation, and pneumonia but less likely exhibited movement disorder than the children did. All of the patients were subjected to corticosteroid treatment, 11 children and 9 adults were treated with intravenous immunoglobulin, and only the adults received plasma exchange or cyclophosphamide. The children recovered faster than the adults, especially in the first 6 months. Risk factors included age, status epilepticus, changes in consciousness, central hypoventilation, and pneumonia. Adults exhibit worse outcomes than children mostly because of status epilepticus.
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Affiliation(s)
- Qi Huang
- Department of Neurology, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Yuan Wu
- Department of Neurology, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China.
| | - Rongfa Qin
- Department of Neurology, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Xing Wei
- Department of Neurology, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Meigang Ma
- Department of Neurology, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
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Jayalakshmi S, Vooturi S. Outcome scores in status epilepticus - predicting the complex clinical situation. Eur J Neurol 2016; 23:1591-1592. [DOI: 10.1111/ene.13124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S. Jayalakshmi
- Department of Neurology; Krishna Institute of Medical Sciences; Secunderabad Telangana India
| | - S. Vooturi
- Department of Neurology; Krishna Institute of Medical Sciences; Secunderabad Telangana India
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Leitinger M, Trinka E, Gardella E, Rohracher A, Kalss G, Qerama E, Höfler J, Hess A, Zimmermann G, Kuchukhidze G, Dobesberger J, Langthaler PB, Beniczky S. Diagnostic accuracy of the Salzburg EEG criteria for non-convulsive status epilepticus: a retrospective study. Lancet Neurol 2016; 15:1054-62. [DOI: 10.1016/s1474-4422(16)30137-5] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/17/2016] [Accepted: 06/14/2016] [Indexed: 01/15/2023]
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34
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Höfler J, Rohracher A, Kalss G, Zimmermann G, Dobesberger J, Pilz G, Leitinger M, Kuchukhidze G, Butz K, Taylor A, Novak H, Trinka E. (S)-Ketamine in Refractory and Super-Refractory Status Epilepticus: A Retrospective Study. CNS Drugs 2016; 30:869-76. [PMID: 27465262 PMCID: PMC4996879 DOI: 10.1007/s40263-016-0371-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim was to describe the safety and efficacy of (S)-ketamine [(S)-KET] in a series of patients with refractory and super-refractory status epilepticus (RSE and SRSE) in a specialized neurological intensive care unit (NICU). METHODS We retrospectively analyzed the data of patients with RSE and SRSE treated with (S)-KET in the NICU, Salzburg, Austria, from 2011 to 2015. Data collection included demographic features, clinical presentation, diagnosis, electroencephalogram (EEG) data, anticonvulsant treatment, timing, and duration of treatment with (S)-KET. Outcomes were seizure control and death. RESULTS A total of 42 patients (14 women) with RSE and SRSE were treated with (S)-KET. The median duration of status epilepticus (SE) was 10 days [first quartile (Q1) 5.0, Q3 21.0]; the median latency from SE onset to the first administration of (S)-KET was 3 days (Q1 2.0, Q3 6.8). Prior to (S)-KET administration, patients had received a median of two (Q1 2.0, Q3 3.0) anesthetics and three (Q1 2.0, Q3 4.0) antiepileptic drugs. Forty percent of patients (17/42) received propofol: 65 % prior to (S)-KET; 35 % at the same time with (S)-KET. Seven patients received a median bolus of (S)-KET of 200 mg (Q1 200, Q3 250) followed by a continuous infusion, while 35 started with a continuous infusion (maximum rate median 2.55 mg/kg/h; Q1 2.09, Q3 3.22). In 64 % of patients (27/42), (S)-KET was the last drug before SE cessation; in five patients, it was given with propofol at the same time. Median duration of administration was 4 days (Q1 2.0, Q3 6.8). Overall (S)-KET treatment was well tolerated, adverse effects were not observed, and overall mortality was 45.2 %. CONCLUSIONS Treatment of SRSE in adult patients with (S)-KET led to resolution of status in 64 %. No adverse events were found, indicating a favorable safety profile.
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Affiliation(s)
- Julia Höfler
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Str. 79, 5020 Salzburg, Austria ,Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Alexandra Rohracher
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Str. 79, 5020 Salzburg, Austria ,Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Gudrun Kalss
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Str. 79, 5020 Salzburg, Austria ,Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Georg Zimmermann
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Str. 79, 5020 Salzburg, Austria ,Centre for Cognitive Neuroscience, Salzburg, Austria ,Department of Mathematics, Paris Lodron University, Salzburg, Austria
| | - Judith Dobesberger
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Str. 79, 5020 Salzburg, Austria ,Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Georg Pilz
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Str. 79, 5020 Salzburg, Austria ,Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Markus Leitinger
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Str. 79, 5020 Salzburg, Austria ,Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Str. 79, 5020 Salzburg, Austria ,Centre for Cognitive Neuroscience, Salzburg, Austria ,Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Kevin Butz
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Str. 79, 5020 Salzburg, Austria ,Centre for Cognitive Neuroscience, Salzburg, Austria ,Department of Psychology, Paris Lodron University, Salzburg, Austria
| | - Alexandra Taylor
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Str. 79, 5020 Salzburg, Austria ,Centre for Cognitive Neuroscience, Salzburg, Austria ,Department of Psychology, Paris Lodron University, Salzburg, Austria
| | - Helmut Novak
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Str. 79, 5020 Salzburg, Austria ,Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria. .,Centre for Cognitive Neuroscience, Salzburg, Austria.
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Leitinger M, Kalss G, Kuchukhidze G, Höfler J, Dobesberger J, Rohracher A, Trinka E. Outcome prediction and reporting in nonconvulsive status epilepticus. Seizure 2015; 33:99. [DOI: 10.1016/j.seizure.2015.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 08/10/2015] [Accepted: 08/10/2015] [Indexed: 11/28/2022] Open
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36
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Leitinger M, Beniczky S, Rohracher A, Gardella E, Kalss G, Qerama E, Höfler J, Hess Lindberg-Larsen A, Kuchukhidze G, Dobesberger J, Langthaler PB, Trinka E. Salzburg Consensus Criteria for Non-Convulsive Status Epilepticus--approach to clinical application. Epilepsy Behav 2015; 49:158-63. [PMID: 26092326 DOI: 10.1016/j.yebeh.2015.05.007] [Citation(s) in RCA: 265] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 05/04/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Salzburg Consensus Criteria for diagnosis of Non-Convulsive Status Epilepticus (SCNC) were proposed at the 4th London-Innsbruck Colloquium on status epilepticus in Salzburg (2013). METHODS We retrospectively analyzed the EEGs of 50 consecutive nonhypoxic patients with diagnoses of nonconvulsive status epilepticus (NCSE) at discharge and 50 consecutive controls with abnormal EEGs in a large university hospital in Austria. We implemented the American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology, 2012 version (ACNS criteria) to increase the test performance of SCNC. In patients without preexisting epileptic encephalopathy, the following criteria were applied: (1) more than 25 epileptiform discharges (ED) per 10-second epoch, i.e., >2.5/s and (2) patients with EDs ≤ 2.5/s or rhythmic delta/theta activity (RDT) exceeding 0.5/s AND at least one of the additional criteria: (2a) clinical and EEG improvements from antiepileptic drugs (AEDs), (2b) subtle clinical phenomena, or (2c) typical spatiotemporal evolution. In case of fluctuation without evolution or EEG improvement without clinical improvement, "possible NCSE" was diagnosed. For identification of RDT, the following criteria were compared: (test condition A) continuous delta-theta activity without further rules, (B) ACNS criterion for rhythmic delta activity (RDA), and (C) ACNS criteria for RDA and fluctuation. RESULTS False positive rate in controls dropped from 28% (condition A) to 2% (B) (p = 0.00039) and finally to 0% (C) (p = 0.000042). Application of test condition C in the group with NCSE gives one false negative (2%). Various EEG patterns were found in patients with NCSE: (1) 8.2%, (2a) 2%, (2b) 12.2%, and (2c) 32.7%. Possible NCSE was diagnosed based on fluctuations in 57.1% and EEG improvement without clinical improvement in 14.2%. CONCLUSION The modified SCNC with refined definitions including the ACNS terminology leads to clinically relevant and statistically significant reduction of false positive diagnoses of NCSE and to minimal loss in sensitivity. This article is part of a Special Issue entitled "Status Epilepticus".
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Affiliation(s)
- M Leitinger
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Centre for Cognitive Neuroscience, Salzburg, Austria.
| | - S Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark; Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark
| | - A Rohracher
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Centre for Cognitive Neuroscience, Salzburg, Austria
| | - E Gardella
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark
| | - G Kalss
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Centre for Cognitive Neuroscience, Salzburg, Austria
| | - E Qerama
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark
| | - J Höfler
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Centre for Cognitive Neuroscience, Salzburg, Austria
| | | | - G Kuchukhidze
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Centre for Cognitive Neuroscience, Salzburg, Austria
| | - J Dobesberger
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Centre for Cognitive Neuroscience, Salzburg, Austria
| | - P B Langthaler
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Centre for Cognitive Neuroscience, Salzburg, Austria
| | - E Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Centre for Cognitive Neuroscience, Salzburg, Austria.
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