Frequency of non-convulsive Seizures and non-convulsive status Epilepticus in Subarachnoid Hemorrhage patients in need of controlled ventilation and sedation
2012 (English)In: Neurocritical Care, ISSN 1541-6933, Vol. 17, no 3, 367-373 p.Article in journal (Refereed) Published
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((R)) 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.
Place, publisher, year, edition, pages
Totowa, NJ, USA: Humana Press, 2012. Vol. 17, no 3, 367-373 p.
Epilepsy, Seizures, Non-convulsive seizures, Continuous electroencephalogram, Subarachnoid hemorrhage
Anesthesiology and Intensive Care
IdentifiersURN: urn:nbn:se:umu:diva-59419DOI: 10.1007/s12028-012-9771-4ISBN: 1556-0961 (Electronic) 1541-6933 (Linking)OAI: oai:DiVA.org:umu-59419DiVA: diva2:552147