Bogdan Florea1, Simona Alexandra Beniczky2, Helga Demény3, Sándor Beniczky4. 1. Epilepsy and EEG Monitoring Center Cluj-Napoca, Romania. 2. Department of Neurology, Copenhagen University Hospital, Rigshospitalet Glostrup, Denmark. 3. Demed Clinics, Cluj-Napoca, Romania. 4. Department of Clinical Neurophysiology, Aarhus University, Aarhus, Denmark; Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark. Electronic address: sbz@filadelfia.dk.
Abstract
PURPOSE: to investigate the semiology of subtle motor phenomena in critically ill patients, with- versus without nonconvulsive status epilepticus (NCSE). METHODS: 60 consecutive comatose patients, in whom subtle motor phenomena were observed in the intensive care unit (ICU), were analysed prospectively. The semiology of the subtle phenomena was described from video-recordings, blinded to all other data. For each patient, the type, location and occurrence-pattern/duration were described. EEGs recorded in the ICU were classified using the Salzburg criteria for NCSE. RESULTS: only 23% (14/60) of the patients had NCSE confirmed by EEG. None of the semiological features could distinguish between patients with NCSE and those without. In both groups, the following phenomena were most common: discrete myoclonic muscle twitching and discrete tonic muscle activation. Besides these, automatisms and eye deviation were observed in both groups. CONCLUSION: subtle motor phenomena in critically ill patients can raise the suspicion of NCSE. Nevertheless, EEG is needed to confirm the diagnosis, since none of the semiological features are specific.
PURPOSE: to investigate the semiology of subtle motor phenomena in critically illpatients, with- versus without nonconvulsive status epilepticus (NCSE). METHODS: 60 consecutive comatosepatients, in whom subtle motor phenomena were observed in the intensive care unit (ICU), were analysed prospectively. The semiology of the subtle phenomena was described from video-recordings, blinded to all other data. For each patient, the type, location and occurrence-pattern/duration were described. EEGs recorded in the ICU were classified using the Salzburg criteria for NCSE. RESULTS: only 23% (14/60) of the patients had NCSE confirmed by EEG. None of the semiological features could distinguish between patients with NCSE and those without. In both groups, the following phenomena were most common: discrete myoclonic muscle twitching and discrete tonic muscle activation. Besides these, automatisms and eye deviation were observed in both groups. CONCLUSION: subtle motor phenomena in critically illpatients can raise the suspicion of NCSE. Nevertheless, EEG is needed to confirm the diagnosis, since none of the semiological features are specific.