Tuesday, September 4, 2012

Frequency of Non-convulsive Seizures and Non-convulsive Status Epilepticus in Subarachnoid Hemorrhag

Abstract
Background  
Non-convulsive seizures (NCSZ) can be more prevalent than previously recognized among comatose neuro-intensive care patients. The aim of this study was to evaluate the frequency of NCSZ and non-convulsive status epilepticus (NCSE) in sedated and ventilated subarachnoid hemorrhage (SAH) patients.
Methods  
Retrospective study at a university hospital neuro-intensive care unit, from January 2008 until June 2010. Patients were treated according to a local protocol, and were initially sedated with midazolam or propofol or combinations of these sedative agents. Thiopental was added for treatment of intracranial hypertension. No wake-up tests were performed. Using NicoletOne® equipment (VIASYS Healthcare Inc., USA), continuous EEG recordings based on four electrodes and a reference electrode was inspected at full length both in a two electrode bipolar and a four-channel referential montage.
Results  
Approximately 5,500 h of continuous EEG were registered in 28 SAH patients (33 % of the patients eligible for inclusion). The median Glasgow Coma scale was 8 (range 3–14) and the median Hunt and Hess score was 4 (range 1–4). During EEG registration, no clinical seizures were observed. In none of the patients inter ictal epileptiform activity was seen. EEG seizures were recorded only in 2/28 (7 %) patients. One of the patients experienced 4 min of an NCSZ and one had a 5 h episode of an NCSE.
Conclusion  
Continuous EEG monitoring is important in detecting NCSZ in sedated patients. Continuous sedation, without wake-up tests, was associated with a low frequency of subclinical seizures in SAH patients in need of controlled ventilation.

  • Content Type Journal Article
  • Category Original Article
  • Pages 1-7
  • DOI 10.1007/s12028-012-9771-4
  • Authors
    • Cecilia Lindgren, Division of Anaesthesiology and Intensive Care, Department of Surgical and Perioperative Sciences, University of Umeå, 90187 Umeå, Sweden
    • Erik Nordh, Division of Clinical Neurophysiology, Department of Pharmacology and Clinical Neurosciences, University of Umeå, 90187 Umeå, Sweden
    • Silvana Naredi, Division of Anaesthesiology and Intensive Care, Department of Surgical and Perioperative Sciences, University of Umeå, 90187 Umeå, Sweden
    • Magnus Olivecrona, Division of Neurosurgery, Department of Pharmacology and Clinical Neurosciences, University of Umeå, 90187 Umeå, Sweden





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