Can Patients with Non-convulsive Seizure Be Identified in the Emergency Department?

Overview

Journal World J Emerg Med

Specialty Emergency Medicine

Date 2017 Jul 7

PMID 28680515

Authors

Gholamreza Sadeghipoor Roodsari

Geetha Chari

Bryan Mera

Shahriar Zehtabchi

Affiliations

Soon will be listed here.

Abstract

Background: Non-convulsive seizure (NCS) is an underdiagnosed, potentially treatable emergency with significant mortality and morbidity. The objective of this study is to examine the characteristics of patients with NCS presenting with altered mental status (AMS) and diagnosed with electroencephalography (EEG), to identify the factors that could increase the pre-test probability of NCS.

Methods: Retrospective study using the data collected prospectively. Inclusion criteria: patients older than 13 years with AMS. Exclusion criteria: (1) immediately correctable AMS (e.g., hypoglycemia, opiod overdose); (2) inability to undergo EEG; (3) hemodynamic instability. Outcomes compared between NCS and non-NCS cases: vital signs, lactate level, gender, witnessed seizure, use of anticonvulsive in the field or in the ED, history of seizure or stroke, head injury, abnormal neurological finding and new abnormal findings on head CT. Data presented as medians and quartiles for categorical and percentages with 95% for continuous variables. Univariate analyses were performed with Man-Whitney and Fisher's Exact tests. A multivariate analysis model was used to test the predictive value of clinical variables in identifying NCS.

Results: From 332 patients (median age 66 years, quartiles 50-78), 16 were diagnosed with NCS (5%, 95% 3%-8%). Only age was significantly different between the NCS vs. non-NCS groups in both univariate (=0.032) and multivariate analyses (=0.016).

Conclusion: Other than age, no other clinically useful variable could identify patients at high risk of NCS. ED physicians should have a high suspicion for NCS and should order EEG for these patients more liberally.

References

Praline J, Grujic J, Corcia P, Lucas B, Hommet C, Autret A . Emergent EEG in clinical practice. Clin Neurophysiol. 2007; 118(10):2149-55. DOI: 10.1016/j.clinph.2007.07.003. View

Tu T, Loh N, Tan N . Clinical risk factors for non-convulsive status epilepticus during emergent electroencephalogram. Seizure. 2013; 22(9):794-7. DOI: 10.1016/j.seizure.2013.05.019. View

Privitera M, Hoffman M, Moore J, Jester D . EEG detection of nontonic-clonic status epilepticus in patients with altered consciousness. Epilepsy Res. 1994; 18(2):155-66. DOI: 10.1016/0920-1211(94)90008-6. View

Shneker B, Fountain N . Assessment of acute morbidity and mortality in nonconvulsive status epilepticus. Neurology. 2003; 61(8):1066-73. DOI: 10.1212/01.wnl.0000082653.40257.0b. View

Trinka E, Cock H, Hesdorffer D, Rossetti A, Scheffer I, Shinnar S . A definition and classification of status epilepticus--Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia. 2015; 56(10):1515-23. DOI: 10.1111/epi.13121. View

Meierkord H, Holtkamp M . Non-convulsive status epilepticus in adults: clinical forms and treatment. Lancet Neurol. 2007; 6(4):329-39. DOI: 10.1016/S1474-4422(07)70074-1. View

Zehtabchi S, Abdel Baki S, Omurtag A, Sinert R, Chari G, Roodsari G . Effect of microEEG on clinical management and outcomes of emergency department patients with altered mental status: a randomized controlled trial. Acad Emerg Med. 2014; 21(3):283-91. PMC: 4047649. DOI: 10.1111/acem.12324. View

Woodford H, George J, Jackson M . Non-convulsive status epilepticus: a practical approach to diagnosis in confused older people. Postgrad Med J. 2015; 91(1081):655-61. DOI: 10.1136/postgradmedj-2015-133537. View

Ziai W, Schlattman D, Llinas R, Venkatesha S, Truesdale M, Schevchenko A . Emergent EEG in the emergency department in patients with altered mental states. Clin Neurophysiol. 2011; 123(5):910-7. DOI: 10.1016/j.clinph.2011.07.053. View

10.

Zehtabchi S, Abdel Baki S, Omurtag A, Sinert R, Chari G, Malhotra S . Prevalence of non-convulsive seizure and other electroencephalographic abnormalities in ED patients with altered mental status. Am J Emerg Med. 2013; 31(11):1578-82. PMC: 3815998. DOI: 10.1016/j.ajem.2013.08.002. View

11.

DeGiorgio C, Heck C, Rabinowicz A, Gott P, Smith T, Correale J . Serum neuron-specific enolase in the major subtypes of status epilepticus. Neurology. 1999; 52(4):746-9. DOI: 10.1212/wnl.52.4.746. View

12.

Shavit L, Grenader T, Galperin I . Nonconvulsive status epilepticus in elderly a possible diagnostic pitfall. Eur J Intern Med. 2012; 23(8):701-4. DOI: 10.1016/j.ejim.2012.06.015. View

13.

Fernandez-Torre J, Kaplan P, Hernandez-Hernandez M . New understanding of nonconvulsive status epilepticus in adults: treatments and challenges. Expert Rev Neurother. 2015; 15(12):1455-73. DOI: 10.1586/14737175.2015.1115719. View

14.

Korn-Lubetzki I, Steiner-Birmanns B, Galperin I, Benasouli Y, Steiner I . Nonconvulsive status epilepticus in older people: a diagnostic challenge and a treatable condition. J Am Geriatr Soc. 2007; 55(9):1475-6. DOI: 10.1111/j.1532-5415.2007.01284.x. View

15.

Husain A, Horn G, Jacobson M . Non-convulsive status epilepticus: usefulness of clinical features in selecting patients for urgent EEG. J Neurol Neurosurg Psychiatry. 2003; 74(2):189-91. PMC: 1738268. DOI: 10.1136/jnnp.74.2.189. View

16.

Bottaro F, Martinez O, Pardal M, Bruetman J, Reisin R . Nonconvulsive status epilepticus in the elderly: a case-control study. Epilepsia. 2007; 48(5):966-72. DOI: 10.1111/j.1528-1167.2007.01033.x. View

17.

Drislane F . Presentation, evaluation, and treatment of nonconvulsive status epilepticus. Epilepsy Behav. 2003; 1(5):301-14. DOI: 10.1006/ebeh.2000.0100. View

18.

Tomson T, Lindbom U, Nilsson B . Nonconvulsive status epilepticus in adults: thirty-two consecutive patients from a general hospital population. Epilepsia. 1992; 33(5):829-35. DOI: 10.1111/j.1528-1157.1992.tb02190.x. View

19.

Fountain N . Status epilepticus: risk factors and complications. Epilepsia. 2000; 41 Suppl 2:S23-30. DOI: 10.1111/j.1528-1157.2000.tb01521.x. View

20.

Chicharro-Ciuffardi A, Gonzalez-Silva M, de Marinis-Palombo A, Gabler-Santalices G . Psychiatric disorders secondary to nonconvulsive status epilepticus of frontal origin. Two clinical case reports. Actas Esp Psiquiatr. 2012; 40(3):155-60. View