PMID- 12383358
OWN - NLM
STAT- MEDLINE
DCOM- 20021204
LR  - 20220318
IS  - 0148-396X (Print)
IS  - 0148-396X (Linking)
VI  - 51
IP  - 5
DP  - 2002 Nov
TI  - Nonconvulsive status epilepticus after subarachnoid hemorrhage.
PG  - 1136-43; discussion 1144
AB  - OBJECTIVE: Although in-hospital seizures have been reported for 3 to 24% of 
      patients with aneurysmal subarachnoid hemorrhage (SAH), nonconvulsive status 
      epilepticus (NCSE) has not been previously described. We sought to determine the 
      frequency and clinical features of NCSE among comatose patients with SAH. 
      METHODS: Between November 1997 and February 2000, we performed continuous 
      electroencephalographic (cEEG) monitoring for at least 24 hours for all patients 
      with aneurysmal SAH who were treated in our neurological intensive care unit and 
      exhibited unexplained coma or neurological deterioration. NCSE was diagnosed when 
      cEEG monitoring demonstrated continuous or repetitive electrographic seizures 
      exceeding 1 hour in duration. Refractory NCSE was treated aggressively with 
      intravenous anticonvulsant administration and continuous-infusion midazolam 
      therapy. RESULTS: Of 233 patients with SAH who survived the first 48 hours of 
      hospitalization, 101 were stuporous or comatose at some point during their 
      hospitalization. Twenty-six of those patients underwent cEEG monitoring, and 
      eight were diagnosed as having NCSE, an average of 18 days (range, 5-38 d) after 
      SAH. All eight patients were receiving prophylactic anticonvulsant therapy. Four 
      patients were persistently comatose and four demonstrated deterioration to stupor 
      or coma; only one exhibited overt tonicoclonic activity. A worst Hunt and Hess 
      grade of IV or V, older age, ventricular drainage, and cerebral edema on computed 
      tomographic scans were identified as risk factors for NCSE (all P < 0.01). NCSE 
      was successfully terminated for five patients (63%), but only one experienced 
      clinical improvement, which was transient; all eight patients eventually died 
      after a period of prolonged coma. CONCLUSION: cEEG monitoring detected NCSE for 
      8% of patients with SAH and otherwise unexplained coma or neurological 
      deterioration. The seizures were highly refractory to therapy, and the prognosis 
      for these patients was extremely poor. Routine postoperative cEEG monitoring of 
      patients with SAH who are at high risk for NCSE, allowing earlier diagnosis and 
      treatment, offers the best chance of improving the outcomes for patients with 
      this disorder.
FAU - Dennis, Lyle J
AU  - Dennis LJ
AD  - Division of Critical Care Neurology, Department of Neurology, College of 
      Physicians and Surgeons, Columbia University, 710 West 168th Street, New York, NY 
      10032, USA.
FAU - Claassen, Jan
AU  - Claassen J
FAU - Hirsch, Lawrence J
AU  - Hirsch LJ
FAU - Emerson, Ronald G
AU  - Emerson RG
FAU - Connolly, E Sander
AU  - Connolly ES
FAU - Mayer, Stephan A
AU  - Mayer SA
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Neurosurgery
JT  - Neurosurgery
JID - 7802914
RN  - 0 (Anticonvulsants)
RN  - R60L0SM5BC (Midazolam)
SB  - IM
MH  - Aged
MH  - Anticonvulsants/administration & dosage/therapeutic use
MH  - Electroencephalography
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Infusion Pumps
MH  - Infusions, Intravenous
MH  - Injections, Intravenous
MH  - Male
MH  - Midazolam/administration & dosage/therapeutic use
MH  - Middle Aged
MH  - Risk Factors
MH  - Status Epilepticus/drug therapy/epidemiology/*etiology/physiopathology
MH  - Subarachnoid Hemorrhage/*complications
MH  - Treatment Outcome
EDAT- 2002/10/18 04:00
MHDA- 2002/12/05 04:00
CRDT- 2002/10/18 04:00
PHST- 2002/01/15 00:00 [received]
PHST- 2002/06/06 00:00 [accepted]
PHST- 2002/10/18 04:00 [pubmed]
PHST- 2002/12/05 04:00 [medline]
PHST- 2002/10/18 04:00 [entrez]
AID - 10.1097/00006123-200211000-00006 [doi]
PST - ppublish
SO  - Neurosurgery. 2002 Nov;51(5):1136-43; discussion 1144. doi: 
      10.1097/00006123-200211000-00006.