Clinical Characteristics and Treatment Outcomes of De Novo Nonconvulsive Status Epilepticus: A Retrospective Study
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Background and Purpose Nonconvulsive status epilepticus (NCSE) is challenging to diagnose. This study aimed to describe and classify the clinical features and electroencephalography (EEG) findings of patients with de novo NCSE and to correlate them with clinical outcomes. Methods We retrospectively reviewed the medical and EEG records of patients admitted to our institution with altered mentation and EEG abnormalities from January 1, 2013 to December 31, 2018. We evaluated premorbid modified Rankin Scale (mRS) scores, underlying disorders, precipitating factors, clinical manifestations, laboratory tests, and outcomes after a 3-month follow-up. Patients who met the Salzburg Consensus Criteria for NCSE were categorized into good-outcome and poor-outcome groups. A good outcome was defined as 1) clinical and electrographic seizures ceasing after treatment, and 2) an mRS score of ≤2 or remaining unchanged during the 3-month follow-up. A poor outcome was defined as 1) death, 2) seizures continuing despite treatment, or 3) a follow-up mRS score of ≥3 in a patient with a premorbid mRS score of ≤2, or a follow-up mRS score that increased in a patient with a premorbid mRS score of ≥3. Results The 48 included patients comprised 37 categorized into the good-outcome group and 11 into the poor-outcome group. The presence of acute metabolic disturbances was significantly correlated with poor outcome (p=0.036), while the other analyzed variables were not significantly correlated with outcomes. Conclusions Acute metabolic disturbances in NCSE are associated with poor outcomes. Adequate treatment of underlying reversible disorders alongside controlling seizures is critical for patients with NCSE.
Abstract
Background and Purpose Nonconvulsive status epilepticus (NCSE) is challenging to diagnose. This study aimed to describe and classify the clinical features and electroencephalography (EEG) findings of patients with de novo NCSE and to correlate them with clinical outcomes. Methods We retrospectively reviewed the medical and EEG records of patients admitted to our institution with altered mentation and EEG abnormalities from January 1, 2013 to December 31, 2018. We evaluated premorbid modified Rankin Scale (mRS) scores, underlying disorders, precipitating factors, clinical manifestations, laboratory tests, and outcomes after a 3-month follow-up. Patients who met the Salzburg Consensus Criteria for NCSE were categorized into good-outcome and poor-outcome groups. A good outcome was defined as 1) clinical and electrographic seizures ceasing after treatment, and 2) an mRS score of ≤2 or remaining unchanged during the 3-month follow-up. A poor outcome was defined as 1) death, 2) seizures continuing despite treatment, or 3) a follow-up mRS score of ≥3 in a patient with a premorbid mRS score of ≤2, or a follow-up mRS score that increased in a patient with a premorbid mRS score of ≥3. Results The 48 included patients comprised 37 categorized into the good-outcome group and 11 into the poor-outcome group. The presence of acute metabolic disturbances was significantly correlated with poor outcome (p=0.036), while the other analyzed variables were not significantly correlated with outcomes. Conclusions Acute metabolic disturbances in NCSE are associated with poor outcomes. Adequate treatment of underlying reversible disorders alongside controlling seizures is critical for patients with NCSE.
참고문헌 (35)
- Kaplan PW, "Assessing the outcomes in patients with nonconvulsive status epilepticus : nonconvulsive status epilepticus is underdiagnosed, potentially overtreated, and confounded by comorbidity", J Clin Neurophysiol, 16, pp.341~352 (1999)
- Shorvon S, "What is nonconvulsive status epilepticus, and what are its subtypes?", Epilepsia, 48(Suppl 8), pp.35~38 (2007)
- Walker M, "Nonconvulsive status epilepticus: Epilepsy Research Foundation workshop reports", Epileptic Disord, 7, pp.253~296 (2005)
- Towne AR, "Prevalence of nonconvulsive status epilepticus in comatose patients", Neurology, 54, pp.340~345 (2000)
- Bearden S, "Diagnosis of nonconvulsive status epilepticus(NCSE)in adults with altered mental status : clinicoelectroencephalographic considerations", Am J Electroneurodiagnostic Technol, 48, pp.11~37 (2008)
- Bottaro FJ, "Nonconvulsive status epilepticus in the elderly : a case-control study", Epilepsia, 48, pp.966~972 (2007)
- Delanty N, "Status epilepticus arising de novo in hospitalized patients : an analysis of 41 patients", Seizure, 10, pp.116~119 (2001)
- Tsai MH, "Factors predictive of outcome in patients with de novo status epilepticus", QJM, 102, pp.57~62 (2009)
- Leitinger M, "Salzburg consensus criteria for non-convulsive status epilepticus--approach to clinical application", Epilepsy Behav, 49, pp.158~163 (2015)
- Sutter R, "Electroencephalographic criteria for nonconvulsive status epilepticus: synopsis and comprehensive survey", Epilepsia, 53(Suppl 3), pp.1~51 (2012)
- Tomson T, "Nonconvulsive status epilepticus in adults : thirty-two consecutive patients from a general hospital population", Epilepsia, 33, pp.829~835 (1992)
- Jordan KG, "Nonconvulsive status epilepticus in acute brain injury", J Clin Neurophysiol, 16, pp.332~340 (1999)
- Kaplan PW, "Nonconvulsive status epilepticus in the emergency room", Epilepsia, 37, pp.643~650 (1996)
- Kang BS, "Etiology and prognosis of non-convulsive status epilepticus", J Clin Neurosci, 21, pp.1915~1919 (2014)
- Fernández-Torre JL, "Cephalosporin-induced nonconvulsive status epilepticus : clinical and electroencephalographic features", Epilepsia, 46, pp.1550~1552 (2005)
- Maganti R, "Nonconvulsive status epilepticus due to cefepime in a patient with normal renal function", Epilepsy Behav, 8, pp.312~314 (2006)
- Koussa SF, "Generalized status epilepticus possibly induced by gatifloxacin", Eur J Neurol, 13, pp.671~672 (2006)
- Kaplan PW, "Lithium-induced confusional states : nonconvulsive status epilepticus or triphasic encephalopathy?", Epilepsia, 47, pp.2071~2074 (2006)
- Vanholder R, "Review on uremic toxins : classification, concentration, and interindividual variability", Kidney Int, 63, pp.1934~1943 (2003)
- Singh BM, "Nonketotic hyperglycemia and epilepsia partialis continua", Arch Neurol, 29, pp.187~190 (1973)
- Singh BM, "Epilepsia partialis continua associated with nonketotic hyperglycemia : clinical and biochemical profile of 21 patients", Ann Neurol, 8, pp.155~160 (1980)
- Maccario M, "Focal seizures as a manifestation of hyperglycemia without ketoacidosis. a report of seven cases with review of the literature", Neurology, 15, pp.195~206 (1965)
- Harden CL, "Hyperglycemia presenting with occipital seizures", Epilepsia, 32, pp.215~220 (1991)
- Pro S, "Non-convulsive status epilepticus characterised exclusively by a language disorder induced by non-ketotic hyperglycaemia", Epileptic Disord, 13, pp.193~196 (2011)
- Guisado R, "Neurologic manifestations of diabetic comas : correlation with biochemical alterations in the brain", Metabolism, 24, pp.665~679 (1975)
- Bhattacharyya S, "Antibiotic-associated encephalopathy", Neurology, 86, pp.963~971 (2016)
- Tüzün E, "Limbic encephalitis and variants : classification, diagnosis and treatment", Neurologist, 13, pp.261~271 (2007)
- Asztely F, "The diagnosis and treatment of limbic encephalitis", Acta Neurol Scand, 126, pp.365~375 (2012)
- Irani SR, "Faciobrachial dystonic seizures precede Lgi1 antibody limbic encephalitis", Ann Neurol, 69, pp.892~900 (2011)
- Machado S, "What should you know about limbic encephalitis?", Arq Neuropsiquiatr, 70, pp.817~822 (2012)
- Schäuble B, "EEG findings in steroid-responsive encephalopathy associated with autoimmune thyroiditis", Clin Neurophysiol, 114, pp.32~37 (2003)
- Kim J, "Hashimoto’s encephalopathy : South Korean experiences", Acta Neurol Belg, 114, pp.209~216 (2014)
- Litt B, "Nonconvulsive status epilepticus in the critically ill elderly", Epilepsia, 39, pp.1194~1202 (1998)
- Lowenstein DH, "Clinical and EEG features of status epilepticus in comatose patients", Neurology, 42, pp.100~104 (1992)
- Shneker BF, "Assessment of acute morbidity and mortality in nonconvulsive status epilepticus", Neurology, 61, pp.1066~1073 (2003)