Cecilia Lindgren1, Erik Nordh, Silvana Naredi, Magnus Olivecrona. 1. Division of Anaesthesiology and Intensive Care, Department of Surgical and Perioperative Sciences, University of Umeå, 90187, Umeå, Sweden. cecilia.lindgren@anestesi.umu.se
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.
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 SAHpatients (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 SAHpatients in need of controlled ventilation.
Authors: P M Vespa; M R Nuwer; V Nenov; E Ronne-Engstrom; D A Hovda; M Bergsneider; D F Kelly; N A Martin; D P Becker Journal: J Neurosurg Date: 1999-11 Impact factor: 5.115
Authors: H Butzkueven; A H Evans; A Pitman; C Leopold; D J Jolley; A H Kaye; C J Kilpatrick; S M Davis Journal: Neurology Date: 2000-11-14 Impact factor: 9.910
Authors: Michael N Diringer; Thomas P Bleck; J Claude Hemphill; David Menon; Lori Shutter; Paul Vespa; Nicolas Bruder; E Sander Connolly; Giuseppe Citerio; Daryl Gress; Daniel Hänggi; Brian L Hoh; Giuseppe Lanzino; Peter Le Roux; Alejandro Rabinstein; Erich Schmutzhard; Nino Stocchetti; Jose I Suarez; Miriam Treggiari; Ming-Yuan Tseng; Mervyn D I Vergouwen; Stefan Wolf; Gregory Zipfel Journal: Neurocrit Care Date: 2011-09 Impact factor: 3.210
Authors: Jan Claassen; Brian T Bateman; Joshua Z Willey; Sarah Inati; Lawrence J Hirsch; Stephan A Mayer; Ralph L Sacco; H Christian Schumacher Journal: Neurosurgery Date: 2007-07 Impact factor: 4.654
Authors: Andrew S Little; John F Kerrigan; Cameron G McDougall; Joseph M Zabramski; Felipe C Albuquerque; Peter Nakaji; Robert F Spetzler Journal: J Neurosurg Date: 2007-05 Impact factor: 5.115
Authors: Daniel Kondziella; Christian K Friberg; Ian Wellwood; Clemens Reiffurth; Martin Fabricius; Jens P Dreier Journal: Neurocrit Care Date: 2015-06 Impact factor: 3.210