Predictors of Nonconvulsive Seizure and Their Effect on Short-term Outcome

Area of Science:

• Neurology
• Critical Care Medicine
• Clinical Neurophysiology

Background:

• Nonconvulsive seizures (NCSs) are prevalent in critically ill adults with acute neurological conditions.
• The impact of NCSs on patient outcomes remains incompletely understood.
• This study investigates the association between NCSs and short-term outcomes in this patient population.

Purpose of the Study:

• To determine the effect of NCSs on short-term patient outcomes.
• To identify clinical and electroencephalogram (EEG) factors associated with NCSs in critically ill adults.

Main Methods:

• Retrospective analysis of 219 adult patients undergoing continuous EEG (cEEG) monitoring from January to June 2018.
• Exclusion of patients with anoxic brain injury.
• Review of clinical, laboratory, and EEG data to identify predictive factors and assess the impact of NCSs on in-hospital mortality, length of stay, and discharge disability (modified Rankin scale ≥ 3).

Main Results:

• 14% (n=31) of patients experienced NCSs.
• Predictive factors for NCSs included prior clinical seizures, epilepsy history, and comatose state.
• EEG findings associated with NCSs were interictal epileptiform discharges, lateralized rhythmic delta activity, and lateralized periodic discharges.
• NCSs were linked to longer hospital stays (P=0.036) and increased disability at discharge (P=0.02).
• No significant association was found between NCSs and in-hospital mortality (P=0.1).

Conclusions:

• Nonconvulsive seizures are associated with prolonged in-hospital stays and higher rates of disability upon discharge in critically ill adult patients.
• NCSs do not appear to significantly influence in-hospital mortality.
• Identifying predictive factors for NCSs can aid in early detection and management.