Clinical Outcomes in patients with brain tumors and Non-Convulsive status Epilepticus treated at New York-Presbyterian Weil Cornell Medical Center
Abstract number :
1.119
Submission category :
3. Neurophysiology / 3C. Other Clinical EEG
Year :
2016
Submission ID :
188245
Source :
www.aesnet.org
Presentation date :
12/3/2016 12:00:00 AM
Published date :
Nov 21, 2016, 18:00 PM
Authors :
Brian Wolf, New York Presbyterian/Weil Cornell Medical Center; Douglas Labar, Weill Medical College of Cornell University; Theodore Schwartz, Weill Cornell Medicine of Cornell University, New York Presbyterian Hospital; and Rajiv Magge, Weil Cornell Medic
Rationale: Patents with brain tumors and altered neurological function often pose a diagnostic challenge. Seizures may be under-recognized and video-electroencephalogram (vEEG) may be helpful. Furthermore, vEEG seizure patterns in these patients have been reported infrequently. This study aims to describe our recent experience with vEEG-confirmed non-convulsive status epilepticus (NCSE) amongst this patient population. Methods: From our Epilepsy and vEEG Monitoring Service records, we identified five consecutive patients admitted with brain tumors and altered mental status, who were ultimately found to be in NCSE on vEEG. We retrospectively reviewed patients' clinical characteristics, anti-epileptic medications, imaging and vEEG findings, and outcomes. Results: All patients had focal-onset partial seizures in the region of their tumors only. There were no focal interictal epileptiform discharges contralateral to the tumors. There was no generalized interictal or ictal activity. All patients were treated with a minimum of two, and a maximum of five, anti-epileptic medications. Duration to diagnosis of NCSE from initial patient presentation ranged from 12 hours to 16 days. Duration to resolution of NCSE ranged from 8 hours to 4 days. One patient did not achieve seizure control and died. Out of the five patients, in total two died and three survived. Of the three survivors, compared to admission baseline, two had post-NCSE improved neurological function, and one had post-NCSE declined neurological function. All patients who died or had persistent declined neurological function post-NCSE had tumor progression on imaging. All patients who survived and whose function improved post-NCSE did not have tumor progression on imaging. Conclusions: A high degree of clinical suspicion along with ready access to vEEG is important in evaluating patients with altered mental status and brain tumors. In these patients, we found NCSE localized to the tumor region, without secondary remote or generalized epileptogenic processes. In our small series, prognosis appears to be more closely related to tumor progression as opposed to ictal activity per se. Funding: None
Neurophysiology