PMID- 37350392 OWN - NLM STAT- MEDLINE DCOM- 20230920 LR - 20230926 IS - 1528-1167 (Electronic) IS - 0013-9580 (Linking) VI - 64 IP - 9 DP - 2023 Sep TI - Diagnosing nonconvulsive status epilepticus: Defining electroencephalographic and clinical response to diagnostic intravenous antiseizure medication trials. PG - 2351-2360 LID - 10.1111/epi.17694 [doi] AB - OBJECTIVE: The Salzburg criteria for nonconvulsive status epilepticus (NCSE) and the American Clinical Neurophysiology Society (ACNS) Standardized Critical Care EEG Terminology 2021 include a diagnostic trial with intravenous (IV) antiseizure medications (ASMs) to assess electroencephalographic (EEG) and clinical response as a diagnostic criterion for definite NCSE and possible NCSE. However, how to perform this diagnostic test and assessing the EEG and clinical responses have not been operationally defined. METHODS: We performed a Delphi process involving six experts to standardize the diagnostic administration of IV ASM and propose operational criteria for EEG and clinical response. RESULTS: Either benzodiazepines (BZDs) or non-BZD ASMs can be used as first choice for a diagnostic IV ASM trial. However, non-BZDs should be considered in patients who already have impaired alertness or are at risk of respiratory depression. Levetiracetam, valproate, lacosamide, brivaracetam, or (if the only feasible drug) fosphenytoin or phenobarbital were deemed appropriate for a diagnostic IV trial. The starting dose should be approximately two thirds to three quarters of the full loading dose recommended for treatment of status epilepticus, with an additional smaller dose if needed. ASMs should be administered during EEG recording under supervision. A monitoring time of at least 15 min is recommended. If there is no response, a second trial with another non-BDZ or BDZs may be considered. A positive EEG response is defined as the resolution of the ictal-interictal continuum pattern for at least three times the longest previously observed spontaneous interval of resolution (if any), but minimum of one continuous minute. For a clinical response, physicians should use a standardized examination before and after IV ASM administration. We suggest a definite time-locked improvement in a focal deficit or at least one-step improvement on a new dedicated one-domain 10-level NCSE response scale. SIGNIFICANCE: The proposed standardized approach of a diagnostic IV ASM trial further refines the ACNS and Salzburg diagnostic criteria for NCSE. CI - (c) 2023 The Authors. Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy. FAU - Leitinger, Markus AU - Leitinger M AUID- ORCID: 0000-0001-8552-6762 AD - Department of Neurology, member of European Reference Network EpiCARE, Center for Cognitive Neuroscience, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria. AD - Neuroscience Institute, Center for Cognitive Neuroscience, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria. FAU - Gaspard, Nicolas AU - Gaspard N AUID- ORCID: 0000-0003-1148-6723 AD - Hopital Universitaire de Bruxelles-Hopital Erasme, Brussels, Belgium. AD - Universite Libre de Bruxelles, Brussels, Belgium. FAU - Hirsch, Lawrence J AU - Hirsch LJ AUID- ORCID: 0000-0002-6333-832X AD - Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA. FAU - Beniczky, Sandor AU - Beniczky S AUID- ORCID: 0000-0002-6035-6581 AD - Department of Clinical Neurophysiology, Danish Epilepsy Center, Dianalund, Denmark. AD - Department of Clinical Neurophysiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. AD - Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. FAU - Kaplan, Peter W AU - Kaplan PW AD - Department of Neurology, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA. FAU - Husari, Khalil AU - Husari K AD - Department of Neurology, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA. FAU - Trinka, Eugen AU - Trinka E AUID- ORCID: 0000-0002-5950-2692 AD - Department of Neurology, member of European Reference Network EpiCARE, Center for Cognitive Neuroscience, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria. AD - Neuroscience Institute, Center for Cognitive Neuroscience, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria. AD - Institute of Public Health, Medical Decision Making and Health Technology Assessment, University for Health Sciences, Medical Informatics, and Technology, Hall in Tyrol, Austria. LA - eng PT - Journal Article DEP - 20230710 PL - United States TA - Epilepsia JT - Epilepsia JID - 2983306R RN - 12794-10-4 (Benzodiazepines) RN - YQE403BP4D (Phenobarbital) SB - IM MH - Humans MH - Administration, Intravenous MH - Benzodiazepines/therapeutic use MH - Electroencephalography MH - Phenobarbital/therapeutic use MH - *Status Epilepticus/diagnosis/drug therapy MH - Clinical Trials as Topic OTO - NOTNLM OT - epilepsy OT - ictal-interictal continuum OT - scale EDAT- 2023/06/23 13:07 MHDA- 2023/09/20 06:42 CRDT- 2023/06/23 06:44 PHST- 2023/06/17 00:00 [revised] PHST- 2023/03/03 00:00 [received] PHST- 2023/06/20 00:00 [accepted] PHST- 2023/09/20 06:42 [medline] PHST- 2023/06/23 13:07 [pubmed] PHST- 2023/06/23 06:44 [entrez] AID - 10.1111/epi.17694 [doi] PST - ppublish SO - Epilepsia. 2023 Sep;64(9):2351-2360. doi: 10.1111/epi.17694. Epub 2023 Jul 10.