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Consequences of Nonconvulsive Status Epilepticus: Experimental and Clinical Evidence

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Status Epilepticus

Part of the book series: Current Clinical Neurology ((CCNEU))

Abstract

Nonconvulsive status epilepticus (NCSE), a prolonged seizure without prominent motor symptoms, occurs frequently in patients with critical neurological and medical illness. The merits of aggressive treatment of NCSE in the critically ill is a topic of serious debate given (a) the difficulty in delineating the prognosis of NCSE from the proximate cause of the illness and (b) the potential negative consequences associated with anesthetic therapies. In this chapter, we provide an update on the prognosis of NCSE as gleaned from preclinical and clinical studies. Although animal models fail to replicate all features of NCSE in the critically ill patient, available preclinical data indicates that NCSE per se can cause direct neuronal injury and neurological morbidity. Clinical data from a growing number of prospective studies in critical care settings including stroke, convulsive status epilepticus, traumatic brain injury, and sepsis are substantiating several retrospective observations that NCSE can both complicate the primary condition and independently worsen prognosis. The current state of knowledge emphasizes the urgent need for more preclinical and prospective studies to identify the long-term prognosis of NCSE. The adoption and increasing early use of Continuous EEG in neurological and medical critical care units can only aid in the development of definitive evidence-based guidelines to treat NCSE.

“Data! Data! Data!” he cried impatiently. “I can’t make bricks without clay”.

Sir Arthur Conan Doyle, The Adventure of the Copper Beeches.

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References

  1. Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S, et al. A definition and classification of status epilepticus—report of the ILAE task force on classification of status Epilepticus. Epilepsia. 2015;56(10):1515–23.

    Article  PubMed  Google Scholar 

  2. Sutter R, Rüegg S, Kaplan PW. Epidemiology, diagnosis, and management of nonconvulsive status epilepticus—opening Pandora’s box. Neurol Clin Pract. 2012;2(4):275–86.

    Article  Google Scholar 

  3. Abend NS. Electrographic status epilepticus in children with critical illness: epidemiology and outcome. Epilepsy Behav. 2015;49:223–7.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Sutter R, Semmlack S, Kaplan PW. Nonconvulsive status epilepticus in adults—insights into the invisible. Nat Rev Neurol. 2016;12(5):281–93.

    Article  CAS  PubMed  Google Scholar 

  5. Sutter R, Fuhr P, Grize L, Marsch S, Rüegg S. Continuous video-EEG monitoring increases detection rate of nonconvulsive status epilepticus in the ICU. Epilepsia. 2011;52(3):453–7.

    Article  PubMed  Google Scholar 

  6. Treiman DM, Delgado-Escuela AV. Complex partial status epilepticus. Adv Neurol. 1983;34:69–81.

    CAS  PubMed  Google Scholar 

  7. Kaplan PW. No, some types of nonconvulsive status epilepticus cause little permanent neurologic sequelae (or: “the cure may be worse than the disease”). Neurophysiol Clin. 2000;30(6):377–82.

    Article  CAS  PubMed  Google Scholar 

  8. Sutter R. Conflicting clinical implications of therapeutic coma for status epilepticus. Crit Care Med. 2015;43(5):1144–5.

    Article  PubMed  Google Scholar 

  9. Marchi NA, Novy J, Faouzi M, Stähli C, Burnand B, Rossetti AO. Status epilepticus: impact of therapeutic coma on outcome. Crit Care Med. 2015;43(5):1003–9.

    Article  PubMed  Google Scholar 

  10. Sutter R, Marsch S, Fuhr P, Kaplan PW, Rüegg S. Anesthetic drugs in status epilepticus: risk or rescue? A 6-year cohort study. Neurology. 2014;82(8):656–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Rossetti AO, Milligan TA, Vulliémoz S, Michaelides C, Bertschi M, Lee JW. A randomized trial for the treatment of refractory status epilepticus. Neurocrit Care. 2011;14(1):4–10.

    Article  CAS  PubMed  Google Scholar 

  12. Schmutzhard E, Pfausler B. Complications of the management of status epilepticus in the intensive care unit. Epilepsia. 2011;52(Suppl 8):39–41.

    Article  CAS  PubMed  Google Scholar 

  13. Kowalski RG, Ziai WC, Rees RN, Werner JK Jr, Kim G, Goodwin H, Geocadin RG. Third-line antiepileptic therapy and outcome in status epilepticus: the impact of vasopressor use and prolonged mechanical ventilation. Crit Care Med. 2012;40(9):2677–84.

    Article  CAS  PubMed  Google Scholar 

  14. Hocker SE, Britton JW, Mandrekar JN, Wijdicks EF, Rabinstein AA. Predictors of outcome in refractory status epilepticus. JAMA Neurol. 2013;70(1):72–7.

    Article  PubMed  Google Scholar 

  15. Young GB, Jordan KG. Do nonconvulsive seizures damage the brain?—yes. Arch Neurol. 1998;55(1):117–9.

    Article  CAS  PubMed  Google Scholar 

  16. Aminoff MJ. Do nonconvulsive seizures damage the brain?—no. Arch Neurol. 1998;55(1):119–20.

    Article  CAS  PubMed  Google Scholar 

  17. Drislane FW. Evidence against permanent neurologic damage from nonconvulsive status epilepticus. J Clin Neurophysiol. 1999;16(4):323–31.

    Google Scholar 

  18. Shneker BF, Fountain NB. Assessment of acute morbidity and mortality in nonconvulsive status epilepticus. Neurology. 2003;61(8):1066–73.

    Article  PubMed  Google Scholar 

  19. Sutter R, Kaplan PW, Marsch S, Hammel EM, Rüegg S, Ziai WC. Early predictors of refractory status epilepticus: an international two-center study. Eur J Neurol. 2015;22(1):79–85.

    Article  CAS  PubMed  Google Scholar 

  20. Bauer G, Trinka E. Nonconvulsive status epilepticus and coma. Epilepsia. 2010;51(2):177–90.

    Article  PubMed  Google Scholar 

  21. Venzi M, Di Giovanni G, Crunelli V. A critical evaluation of the gamma-hydroxybutyrate (GHB) model of absence seizures. CNS Neurosci Ther. 2015;21(2):123–40.

    Article  CAS  PubMed  Google Scholar 

  22. Snead OC 3rd. gamma-Hydroxybutyrate model of generalized absence seizures: further characterization and comparison with other absence models. Epilepsia. 1988;29(4):361–8.

    Article  CAS  PubMed  Google Scholar 

  23. Marescaux C, Micheletti G, Vergnes M, Depaulis A, Rumbach L, Warter JM. A model of chronic spontaneous petit mal-like seizures in the rat: comparison with pentylenetetrazol-induced seizures. Epilepsia. 1984;25(3):326–31.

    Article  CAS  PubMed  Google Scholar 

  24. Ben-Ari Y, Lagowska J, Tremblay E, Le Gal La Salle G. A new model of focal status epilepticus: intra-amygdaloid application of kainic acid elicits repetitive secondarily generalized convulsive seizures. Brain Res.1979;163(1):176–9.

    Google Scholar 

  25. Sloviter RS, Damiano BP. Sustained electrical stimulation of the perforant path duplicates kainate-induced electrophysiological effects and hippocampal damage in rats. Neurosci Lett. 1981;24(3):279–84.

    Article  CAS  PubMed  Google Scholar 

  26. Thompson K, Holm AM, Schousboe A, Popper P, Micevych P, Wasterlain C. Hippocampal stimulation produces neuronal death in the immature brain. Neuroscience. 1998;82(2):337–48.

    Article  CAS  PubMed  Google Scholar 

  27. Brandt C, Glien M, Potschka H, Volk H, Löscher W. Epileptogenesis and neuropathology after different types of status epilepticus induced by prolonged electrical stimulation of the basolateral amygdala in rats. Epilepsy Res. 2003;55(1–2):83–103.

    Article  PubMed  Google Scholar 

  28. Meldrum BS, Vigouroux RA, Brierley JB. Systemic factors and epileptic brain damage. Prolonged seizures in paralyzed, artificially ventilated baboons. Arch Neurol. 1973;29(2):82–7.

    Article  CAS  PubMed  Google Scholar 

  29. Meldrum BS, Vigouroux RA, Rage P, Brierley JB. Hippocampal lesions produced by prolonged seizures in paralyzed artificially ventilated baboons. Experientia. 1973;29(5):561–3.

    Article  CAS  PubMed  Google Scholar 

  30. Nevander G, Ingvar M, Auer R, Siesjö BK. Status epilepticus in well-oxygenated rats causes neuronal necrosis. Ann Neurol. 1985;18(3):281–90.

    Article  CAS  PubMed  Google Scholar 

  31. Hartings JA, Williams AJ, Tortella FC. Occurrence of nonconvulsive seizures, periodic epileptiform discharges, and intermittent rhythmic delta activity in rat focal ischemia. Exp Neurol. 2003;179(2):139–49.

    Article  PubMed  Google Scholar 

  32. Williams AJ, Tortella FC, Lu XM, Moreton JE, Hartings JA. Antiepileptic drug treatment of nonconvulsive seizures induced by experimental focal brain ischemia. J Pharmacol Exp Ther. 2004;311(1):220–7.

    Article  CAS  PubMed  Google Scholar 

  33. Cuomo O, Rispoli V, Leo A, Politi GB, Vinciguerra A, di Renzo G, Cataldi M. The antiepileptic drug levetiracetam suppresses non-convulsive seizure activity and reduces ischemic brain damage in rats subjected to permanent middle cerebral artery occlusion. PLoS ONE. 2013;8(11):e80852. doi:10.1371/journal.pone.0080852.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Pisani F, Copioli C, Di Gioia C, Turco E, Sisti L. Neonatal seizures: relation of ictal video-electroencephalography (EEG) findings with neurodevelopmental outcome. J Child Neurol. 2008;23(4):394–8.

    Article  PubMed  Google Scholar 

  35. Hosain S, La Vega-Talbott M, Solomon G, Green N. Apneic seizures in infants: role of continuous EEG monitoring. Clin Electroencephalogr. 2003;34(4):197–200.

    Article  CAS  PubMed  Google Scholar 

  36. Jette N, Claassen J, Emerson RG, Hirsch LJ. Frequency and predictors of nonconvulsive seizures during continuous electroencephalographic monitoring in critically ill children. Arch Neurol. 2006;63(12):1750–5.

    Article  PubMed  Google Scholar 

  37. Abend NS, Dlugos DJ. Nonconvulsive status epilepticus in a pediatric intensive care unit. Pediatr Neurol. 2007;37(3):165–70.

    Article  PubMed  Google Scholar 

  38. Abend NS, Gutierrez-Colina AM, Monk HM, Dlugos DJ, Clancy RR. Levetiracetam for treatment of neonatal seizures. J Child Neurol. 2011;26(4):465–70.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Abend NS, Sanchez SM, Berg RA, Dlugos DJ, Topjian AA. Treatment of electrographic seizures and status epilepticus in critically ill children: a single center experience. Seizure. 2013;22(6):467–71.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Abend NS, Wusthoff CJ, Goldberg EM, Dlugos DJ. Electrographic seizures and status epilepticus in critically ill children and neonates with encephalopathy. Lancet Neurol. 2013;12(12):1170–9.

    Article  PubMed  Google Scholar 

  41. Topjian AA, Gutierrez-Colina AM, Sanchez SM, Berg RA, Friess SH, Dlugos DJ, Abend NS. Electrographic status epilepticus is associated with mortality and worse short-term outcome in critically ill children. Crit Care Med. 2013;41(1):215–23.

    Article  PubMed  Google Scholar 

  42. Wagenman KL, Blake TP, Sanchez SM, Schultheis MT, Radcliffe J, Berg RA, et al. Electrographic status epilepticus and long-term outcome in critically ill children. Neurology. 2014;82(5):396–404.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Payne ET, Hahn CD. Continuous electroencephalography for seizures and status epilepticus. Curr Opin Pediatr. 2014;26(6):675–81.

    Article  PubMed  Google Scholar 

  44. Kirkham FJ, Wade AM, McElduff F, Boyd SG, Tasker RC, Edwards M, et al. Seizures in 204 comatose children: incidence and outcome. Intensive Care Med. 2012;38(5):853–62.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Manning DJ, Rosenbloom L. Non-convulsive status epilepticus. Arch Dis Child. 1987;62(1):37–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Lambrechtsen FA, Buchhalter JR. Aborted and refractory status epilepticus in children: a comparative analysis. Epilepsia. 2008;49(4):615–25.

    Article  PubMed  Google Scholar 

  47. Schreiber JM, Zelleke T, Gaillard WD, Kaulas H, Dean N, Carpenter JL. Continuous video EEG for patients with acute encephalopathy in a pediatric intensive care unit. Neurocrit Care. 2012;17(1):31–8.

    Article  PubMed  Google Scholar 

  48. Greiner HM, Holland K, Leach JL, Horn PS, Hershey AD, Rose DF. Nonconvulsive status epilepticus: the encephalopathic pediatric patient. Pediatrics. 2012;129(3):e748–55.

    Article  PubMed  Google Scholar 

  49. Scholtes FB, Renier WO, Meinardi H. Non-convulsive status epilepticus: causes, treatment, and outcome in 65 patients. J Neurol Neurosurg Psychiatry. 1996;61(1):93–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Labar D, Barrera J, Solomon G, Harden C. Nonconvulsive status epilepticus in the elderly: a case series and a review of the literature. J Epilepsy. 1998;11(2):74–8.

    Article  Google Scholar 

  51. Litt B, Wityk RJ, Hertz SH, Mullen PD, Weiss H, Ryan DD, Henry TR. Nonconvulsive status epilepticus in the critically ill elderly. Epilepsia. 1998;39(11):1194–202.

    Article  CAS  PubMed  Google Scholar 

  52. Jordan KG. Nonconvulsive status epilepticus in acute brain injury. J Clin Neurophysiol. 1999;16(4):332–40.

    Google Scholar 

  53. Power KN, Gramstad A, Gilhus NE, Engelsen BA. Adult nonconvulsive status epilepticus in a clinical setting: Semiology, aetiology, treatment and outcome. Seizure. 2015;24:102–6.

    Article  PubMed  Google Scholar 

  54. Jumao-as A, Brenner RP. Myoclonic status epilepticus: a clinical and electroencephalographic study. Neurology. 1990;40(8):1199–202.

    Article  CAS  PubMed  Google Scholar 

  55. Drislane FW, Schomer DL. Clinical implications of generalized electrographic status epilepticus. Epilepsy Res. 1994;19(2):111–21.

    Article  CAS  PubMed  Google Scholar 

  56. Privitera M, Hoffman M, Moore JL, Jester D. EEG detection of nontonic-clonic status epilepticus in patients with altered consciousness. Epilepsy Res. 1994;18(2):155–66.

    Article  CAS  PubMed  Google Scholar 

  57. Oddo M, Carrera E, Claassen J, Mayer SA, Hirsch LJ. Continuous electroencephalography in the medical intensive care unit. Crit Care Med. 2009;37(6):2051–6.

    Article  PubMed  Google Scholar 

  58. Waterhouse EJ, Vaughan JK, Barnes TY, Boggs JG, Towne AR, Kopec-Garnett L, DeLorenzo RJ. Synergistic effect of status epilepticus and ischemic brain injury on mortality. Epilepsy Res. 1998;29(3):175–83.

    Article  CAS  PubMed  Google Scholar 

  59. Payne ET, Zhao XY, Frndova H, McBain K, Sharma R, Hutchison JS, Hahn CD. Seizure burden is independently associated with short term outcome in critically ill children. Brain. 2014;137(Pt 5):1429–38.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Holmes GL. To know or not to know: does EEG monitoring in the paediatric intensive care unit add anything besides cost? Brain. 2014;137(Pt 5):1276–7.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Hesdorffer DC, Logroscino G, Cascino G, Annegers JF, Hauser WA. Risk of unprovoked seizure after acute symptomatic seizure: effect of status epilepticus. Ann Neurol. 1998;44(6):908–12.

    Article  CAS  PubMed  Google Scholar 

  62. Punia V, Garcia CG, Hantus S. Incidence of recurrent seizures following hospital discharge in patients with LPDs (PLEDs) and nonconvulsive seizures recorded on continuous EEG in the critical care setting. Epilepsy Behav. 2015;49:250–4.

    Article  PubMed  Google Scholar 

  63. Spiller HA, Gorman SE, Villalobos D, Benson BE, Ruskosky DR, Stancavage MM, Anderson DL. Prospective multicenter evaluation of tramadol exposure. J Toxicol Clin Toxicol. 1997;35(4):361–4.

    Article  CAS  PubMed  Google Scholar 

  64. De Marchis GM, Pugin D, Meyers E, Velasquez A, Suwatcharangkoon S, Park S, et al. Seizure burden in subarachnoid hemorrhage associated with functional and cognitive outcome. Neurology. 2016;86(3):253–60.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Vespa PM, McArthur DL, Xu Y, Eliseo M, Etchepare M, Dinov I, et al. Nonconvulsive seizures after traumatic brain injury are associated with hippocampal atrophy. Neurology. 2010;75(9):792–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Kurtz P, Gaspard N, Wahl AS, Bauer RM, Hirsch LJ, Wunsch H, Claassen J. Continuous electroencephalography in a surgical intensive care unit. Intensive Care Med. 2014;40(2):228–34.

    Article  PubMed  Google Scholar 

  67. Claassen J, Albers D, Schmidt JM, De Marchis GM, Pugin D, Falo CM, et al. Nonconvulsive seizures in subarachnoid hemorrhage link inflammation and outcome. Ann Neurol. 2014;75(5):771–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Jafarpour S, Loddenkemper T. Outcomes in pediatric patients with nonconvulsive status epilepticus. Epilepsy Behav. 2015;49:98–103.

    Article  PubMed  Google Scholar 

  69. Fernandez-Torre JL, Kaplan PW, Hernandez-Hernandez MA. New understanding of nonconvulsive status epilepticus in adults: treatments and challenges. Expert Rev Neurother. 2015;15(12):1455–73.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Departments of Neurology and Pediatrics, University of Virginia, 800394, Charlottesville, VA, 22908, USA

    Howard P. Goodkin

  2. Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, 8813, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA

    Karthik Rajasekaran

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  1. Karthik Rajasekaran
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  2. Howard P. Goodkin
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Correspondence to Howard P. Goodkin .

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Editors and Affiliations

  1. Department of Neurology, Harvard Medical School, Comprehensive Epilepsy Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

    Frank W. Drislane

  2. Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA

    Peter W. Kaplan MBBS

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Rajasekaran, K., Goodkin, H.P. (2018). Consequences of Nonconvulsive Status Epilepticus: Experimental and Clinical Evidence. In: Drislane, F., Kaplan MBBS, P. (eds) Status Epilepticus. Current Clinical Neurology. Springer, Cham. https://doi.org/10.1007/978-3-319-58200-9_25

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  • DOI: https://doi.org/10.1007/978-3-319-58200-9_25

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