Journal of Neurology

, Volume 261, Issue 11, pp 2136–2142 | Cite as

Non-convulsive status epilepticus after ischemic stroke: a hospital-based stroke cohort study

  • Vincenzo Belcastro
  • Simone Vidale
  • Gaetano Gorgone
  • Laura Rosa Pisani
  • Luigi Sironi
  • Marco Arnaboldi
  • Francesco Pisani
Original Communication


To evaluate in the setting of a stroke unit ward the usefulness of a prolonged (>6 h) video-EEG recording (PVEEG) in identifying non-convulsive status epilepticus (NCSE) in patients with an acute ischemic stroke. Predictors of NCSE were also evaluated. Patients with an acute ischemic stroke, referred to our unit, were included in this prospective observational study. A PVEEG recording was implemented after stroke in all patients during the first week: (a) promptly in those exhibiting a clear or suspected epileptic manifestation; (b) at any time during the routine activity in the remaining patients. After the first week, a standard EEG/PVEEG recording was hooked up only in presence of an evident or suspected epileptic manifestation or as control of a previous epileptic episode. NCSE was identified in 32 of the 889 patients (3.6 %) included in the study. It occurred early (within the first week) in 20/32 (62.5 %) patients and late in the remaining 12. Diagnosis was made on the basis of a specific clinical suspect (n = 19, 59.4 %) or without any suspect (n = 13, 40.6 %). In a multivariate analysis, a significant association of NCSE was observed with NIHSS score, infarct size and large atherothrombotic etiology. NCSE is not a rare event after an acute ischemic stroke and a delayed diagnosis could worsen patient prognosis. Since NCSE can be difficult to be diagnosed only on clinical grounds, implementation of a prompt PVEEG should be kept available in a stroke unit whenever a patient develop signs, although subtle, consistent with NCSE.


Non-convulsive status epilepticus Post-stroke seizures Prolonged video-EEG recording 



We would like to acknowledge the contribution of Neurology EEG technologists of S. Anna Hospital in connecting these patients to the PVEEG at all odd hours.

Conflicts of interest



  1. 1.
    So EL, Annegers JF, Hauser WA, O’Brien PC, Whisnant JP (1996) Population-based study of seizure disorders after cerebral infarction. Neurology 46:350–355CrossRefPubMedGoogle Scholar
  2. 2.
    Graham NS, Crichton S, Koutroumanidis M, Wolfe CD, Rudd AG (2013) Incidence and associations of post-stroke epilepsy: the prospective South London stroke register. Stroke 44:605–611CrossRefPubMedGoogle Scholar
  3. 3.
    Ryvlin P, Montavont A, Nighoghossian N (2006) Optimizing therapy of seizures in stroke patients. Neurology 67:S3–S9CrossRefPubMedGoogle Scholar
  4. 4.
    Lossius MI, Ronning OM, Slapo GD, Mowinckel P, Gjerstad L (2005) Post-stroke epilepsy: occurrence and predictors: a long-term prospective controlled study (Akershus Stroke Study). Epilepsia 46:1246–1251CrossRefPubMedGoogle Scholar
  5. 5.
    Camilo O, Goldstein LB (2004) Seizures and epilepsy after ischemic stroke. Stroke 35:1769–1775CrossRefPubMedGoogle Scholar
  6. 6.
    Afsar N, Kaya D, Aktan S, Aykut-Bingol C (2003) Stroke and status epilepticus: stroke type, type of status epilepticus, and prognosis. Seizure 12:23–27CrossRefPubMedGoogle Scholar
  7. 7.
    Beghi E, D’Alessandro R, Beretta S et al (2011) Incidence and predictors of acute symptomatic seizures after stroke. Neurology 77:1785–1793CrossRefPubMedGoogle Scholar
  8. 8.
    Pezzini A, Grassi M, Del Zotto E et al (2013) Complications of acute stroke and the occurrence of early seizures. Cerebrovasc Dis 35:444–450CrossRefPubMedGoogle Scholar
  9. 9.
    Labovitz DL, Hauser WA, Sacco RL (2001) Prevalence and predictors of early seizure and status epilepticus after first stroke. Neurology 57:200–206CrossRefPubMedGoogle Scholar
  10. 10.
    Velioglu SK, Özmenoglu M, Boz C, Alioglu Z (2001) Status epilepticus after stroke. Stroke 32:1169–1172CrossRefPubMedGoogle Scholar
  11. 11.
    Procaccianti G, Zaniboni A, Rondelli F, Crisci M, Sacquengna T (2012) Seizures in acute stroke: incidence, risk factors and prognosis. Neuroepidemiology 39:45–50CrossRefPubMedGoogle Scholar
  12. 12.
    Kilpatrick CJ, Davis SM, Tress B et al (1990) Epileptic seizures in acute stroke. Arch Neurol 47:157–160CrossRefPubMedGoogle Scholar
  13. 13.
    Rumbach L, Sablot D, Berger E, Tatu L, Vuillier F, Moulin T (2000) Status epilepticus in stroke: report on a hospital-based stroke cohort. Neurology 54:350–354CrossRefPubMedGoogle Scholar
  14. 14.
    Bateman BT, Claassen J, Willey JZ et al (2007) Convulsive status epilepticus after ischemic stroke and intracerebral haemorrhage: frequency, predictors, and impact on outcome in a large administrative dataset. Neurocrit Care 7:187–193CrossRefPubMedGoogle Scholar
  15. 15.
    Towne AR, Waterhouse EJ, Boggs JG et al (2000) Prevalence of nonconvulsive status epilepticus in comatose patients. Neurology 25:340–345CrossRefGoogle Scholar
  16. 16.
    Young GB, Jordan KG, Doig GS (1996) An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology 47:83–89CrossRefPubMedGoogle Scholar
  17. 17.
    De Lorenzo RJ, Waterhouse EJ, Towne AR et al (1998) Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia 39:833–840CrossRefGoogle Scholar
  18. 18.
    Bottaro FJ, Martinez OA, Pardal MM, Bruetman JE, Reisin RC (2007) Nonconvulsive status epilepticus in the elderly: a case–control study. Epilepsia 48:966–972CrossRefPubMedGoogle Scholar
  19. 19.
    Ney JP, van der Goes DN, Nuwer MR, Nelson L, Eccher MA (2013) Continuous and routine EEG in intensive care: utilization and outcomes, United States 2005–2009. Neurology 81:2002–2008PubMedCentralCrossRefPubMedGoogle Scholar
  20. 20.
    Sutter R, Stevens RD, Kaplan PW (2013) Continuous electroencephalographic monitoring in critically ill patients: indications, limitations, and strategies. Crit Care Med 41:1124–1132CrossRefPubMedGoogle Scholar
  21. 21.
    Shorvon S (2011) The treatment of status epilepticus. Curr Opin Neurol 24:165–170CrossRefPubMedGoogle Scholar
  22. 22.
    Burn J, Dennis M, Bamford J, Sandercock P, Wade D, Warlow C (1994) Long-term risk of recurrent stroke after a first-ever stroke. The Oxfordshire Community Stroke Project. Stroke 25:333–337CrossRefPubMedGoogle Scholar
  23. 23.
    Goldstein LB, Jones MR, Matchar D et al (2001) Improving the reliability of stroke subgroup classification using the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. Stroke 32:1091–1098CrossRefPubMedGoogle Scholar
  24. 24.
    Brott T, Adams HP Jr, Olinger CP et al (1989) Measurements of acute cerebral infarction: a clinical examination scale. Stroke 20:864–870CrossRefPubMedGoogle Scholar
  25. 25.
    van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607CrossRefPubMedGoogle Scholar
  26. 26.
    Heiss WD, Huber M, Fink GR et al (1992) Progressive derangement of periinfarct viable tissue in ischemic stroke. J Cereb Blood Flow Metab 12:193–203CrossRefPubMedGoogle Scholar
  27. 27.
    Luhmann HJ, Mudrick-Donnon LA, Mittmann T, Heinemann U (1995) Ischemia-induced long-term hyperexcitability in rat neocortex. Eur J Neurosci 7:180–191CrossRefPubMedGoogle Scholar
  28. 28.
    Belcastro V, Pierguidi L, Tambasco N (2011) Levetiracetam in brain ischemia: clinical implications in neuroprotection and prevention of post-stroke epilepsy. Brain Dev 33:289–293CrossRefPubMedGoogle Scholar
  29. 29.
    Mead GE, Lewis SC, Wardlaw JM, Dennis MS, Warlow CP (2000) How well does the Oxfordshire community stroke project classification predict the site and size of the infarct on brain imaging? J Neurol Neurosurg Psychiatry 68:558–562PubMedCentralCrossRefPubMedGoogle Scholar
  30. 30.
    Mayer SA, Claassen J, Lokin J, Mendelsohn F, Dennis LJ, Fitzsimmons BF (2002) Refractory status epilepticus: frequency, risk factors, and impact on outcome. Arch Neurol 59:205–210CrossRefPubMedGoogle Scholar
  31. 31.
    Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ (2004) Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology 62:1743–1748CrossRefPubMedGoogle Scholar
  32. 32.
    Meierkord H, Holtkamp M (2007) Non-convulsive status epilepticus in adults: clinical forms and treatment. Lancet Neurol 6:329–339CrossRefPubMedGoogle Scholar
  33. 33.
    Claassen J, Lokin JK, Fitzsimmons BF, Mendelsohn FA, Mayer SA (2002) Predictors of functional disability and mortality after status epilepticus. Neurology 58:139–142CrossRefPubMedGoogle Scholar
  34. 34.
    Jordan KG (2004) Emergency EEG and continuous EEG monitoring in acute ischemic stroke. J Clin Neurophysiol 21:341–352PubMedGoogle Scholar
  35. 35.
    Carrera E, Michel P, Despland PA et al (2006) Continuous assessment of electrical epileptic activity in acute stroke. Neurology 67:99–104CrossRefPubMedGoogle Scholar
  36. 36.
    Sutter R, Fuhr P, Grize L, Marsch S, Rüegg S (2011) Continuous video-EEG monitoring increases detection rate of nonconvulsive status epilepticus in the ICU. Epilepsia 52:453–457CrossRefPubMedGoogle Scholar
  37. 37.
    Huang CW, Saposnik G, Fang J, Steven DA, Burneo JG (2014) Influence of seizures on stroke outcomes: a large multicenter study. Neurology 82:768–776CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Vincenzo Belcastro
    • 1
  • Simone Vidale
    • 1
  • Gaetano Gorgone
    • 2
  • Laura Rosa Pisani
    • 3
  • Luigi Sironi
    • 1
  • Marco Arnaboldi
    • 1
  • Francesco Pisani
    • 4
  1. 1.Neurology UnitS. Anna HospitalComoItaly
  2. 2.Neurology UnitTreviglio-Caravaggio HospitalTreviglioItaly
  3. 3.IRCCS Centro Neurolesi “Bonino-Pulejo”MessinaItaly
  4. 4.Department of NeurosciencesUniversity of MessinaMessinaItaly

Personalised recommendations