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Nonconvulsive status epilepticus after subarachnoid hemorrhage
Lyle J Dennis1, Jan Claassen, Lawrence J Hirsch
1Division of Critical Care Neurology, Department of Neurology, College of Physicians and Surgeons, Columbia University, 710 West 168th Street, New York, NY 10032, USA.
Neurosurgery
|October 18, 2002
Summary
Nonconvulsive status epilepticus (NCSE) occurred in 8% of comatose subarachnoid hemorrhage (SAH) patients, often refractory to treatment. Early continuous EEG monitoring is crucial for diagnosing NCSE in high-risk SAH patients.
Area of Science:
- Neurology
- Critical Care Medicine
- Epileptology
Background:
- In-hospital seizures affect 3-24% of aneurysmal subarachnoid hemorrhage (SAH) patients.
- Nonconvulsive status epilepticus (NCSE) has not been previously described in this population.
Purpose of the Study:
- To determine the frequency and clinical features of NCSE among comatose patients with aneurysmal SAH.
- To investigate risk factors and outcomes associated with NCSE in SAH patients.
Main Methods:
- Continuous electroencephalographic (cEEG) monitoring was performed for at least 24 hours on SAH patients with unexplained coma or neurological deterioration.
- NCSE was diagnosed based on cEEG findings of continuous or repetitive electrographic seizures exceeding 1 hour.
- Refractory NCSE was treated with anticonvulsants and midazolam infusion.
Main Results:
- NCSE was diagnosed in 8% of monitored SAH patients (8 out of 101), an average of 18 days post-SAH.
- Risk factors included severe SAH grade (IV-V), older age, ventricular drainage, and cerebral edema.
- NCSE was refractory to treatment, with only transient clinical improvement in one patient; all eight patients died after prolonged coma.
Conclusions:
- Continuous EEG monitoring detected NCSE in 8% of SAH patients with unexplained coma or deterioration.
- NCSE in SAH patients is highly refractory and associated with an extremely poor prognosis.
- Routine postoperative cEEG monitoring for high-risk SAH patients may improve outcomes by enabling earlier diagnosis and treatment.