TY - JOUR
T1 - Electroencephalographic Seizures in Emergency Department Patients After Treatment for Convulsive Status Epilepticus
AU - Zehtabchi, Shahriar
AU - Silbergleit, Robert
AU - Chamberlain, James M.
AU - Shinnar, Shlomo
AU - Elm, Jordan J.
AU - Underwood, Ellen
AU - Rosenthal, Eric S.
AU - Bleck, Thomas P.
AU - Kapur, Jaideep
N1 - Funding Information:
The ESETT was supported by grants (U01NS088034, U01NS088023, U01NS056975, U01NS059041, and U01NS073476) from the National Institute of Neurological Disorders and Stroke.
Publisher Copyright:
© 2020 by the American Clinical Neurophysiology Society.
PY - 2022/9/1
Y1 - 2022/9/1
N2 - Purpose:It is unknown how often and how early EEG is obtained in patients presenting with status epilepticus. The Established Status Epilepticus Treatment Trial enrolled patients with benzodiazepine-refractory seizures and randomized participants to fosphenytoin, levetiracetam, or valproate. The use of early EEG, including frequency of electrographic seizures, was determined in Established Status Epilepticus Treatment Trial participants.Methods:Secondary analysis of 475 enrollments at 58 hospitals to determine the frequency of EEG performed within 24 hours of presentation. The EEG type, the prevalence of electrographic seizures, and characteristics associated with obtaining early EEG were recorded. Chi-square and Wilcoxon rank-sum tests were calculated as appropriate for univariate and bivariate comparisons. Odds ratios are reported with 95% confidence intervals.Results:A total of 278 of 475 patients (58%) in the Established Status Epilepticus Treatment Trial cohort underwent EEG within 24 hours (median time to EEG: 5 hours [interquartile range: 3-10]). Electrographic seizure prevalence was 14% (95% confidence interval, 10%-19%; 39/278) in the entire cohort and 13% (95% confidence interval, 7%-21%) in the subgroup of patients meeting the primary outcome of the Established Status Epilepticus Treatment Trial (clinical treatment success within 60 minutes of randomization). Among subjects diagnosed with electrographic seizures (39), 15 (38%; 95% confidence interval, 25%-54%) had no clinical correlate on the video EEG recording.Conclusions:Electrographic seizures may occur in patients who stop seizing clinically after treatment of convulsive status epilepticus. Clinical correlates might not be present during electrographic seizures. These findings support early initiation of EEG recordings in patients suffering from convulsive status epilepticus, including those with clinical evidence of treatment success.
AB - Purpose:It is unknown how often and how early EEG is obtained in patients presenting with status epilepticus. The Established Status Epilepticus Treatment Trial enrolled patients with benzodiazepine-refractory seizures and randomized participants to fosphenytoin, levetiracetam, or valproate. The use of early EEG, including frequency of electrographic seizures, was determined in Established Status Epilepticus Treatment Trial participants.Methods:Secondary analysis of 475 enrollments at 58 hospitals to determine the frequency of EEG performed within 24 hours of presentation. The EEG type, the prevalence of electrographic seizures, and characteristics associated with obtaining early EEG were recorded. Chi-square and Wilcoxon rank-sum tests were calculated as appropriate for univariate and bivariate comparisons. Odds ratios are reported with 95% confidence intervals.Results:A total of 278 of 475 patients (58%) in the Established Status Epilepticus Treatment Trial cohort underwent EEG within 24 hours (median time to EEG: 5 hours [interquartile range: 3-10]). Electrographic seizure prevalence was 14% (95% confidence interval, 10%-19%; 39/278) in the entire cohort and 13% (95% confidence interval, 7%-21%) in the subgroup of patients meeting the primary outcome of the Established Status Epilepticus Treatment Trial (clinical treatment success within 60 minutes of randomization). Among subjects diagnosed with electrographic seizures (39), 15 (38%; 95% confidence interval, 25%-54%) had no clinical correlate on the video EEG recording.Conclusions:Electrographic seizures may occur in patients who stop seizing clinically after treatment of convulsive status epilepticus. Clinical correlates might not be present during electrographic seizures. These findings support early initiation of EEG recordings in patients suffering from convulsive status epilepticus, including those with clinical evidence of treatment success.
KW - Convulsive status epilepticus
KW - EEG
KW - Electrographic status epilepticus
KW - Grand Mal status epilepticus
KW - Nonconvulsive seizures
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U2 - 10.1097/WNP.0000000000000800
DO - 10.1097/WNP.0000000000000800
M3 - Article
C2 - 33337664
AN - SCOPUS:85122694047
SN - 0736-0258
VL - 39
SP - 441
EP - 445
JO - Journal of Clinical Neurophysiology
JF - Journal of Clinical Neurophysiology
IS - 6
ER -