Abstracts

Rationale: Nonconvulsive status epilepticus (NCSE) is a range of conditions in which electrographic seizure activity results in prolonged behaviour disturbance or mental status deterioriation. Eight percent of comatose patients may present with NCSE. Other clinical and epidemiological factors seem to influence the occurrence of NCSE. In general, the incidence of status epilepticus shows a strong age-dependency being more frequently in elderly people. While absence and partial complex status in epileptic patients have good response to therapy, NCSE in comatose patients has a poor prognosis. About 1% of cases with stroke may complicate with status, and NCSE is commoner than convulsive SE. NCSE was found in 6% of patients with systemic cancer presenting with altered mental status who had no evidence of CNS metastasis, but there is little information concerning the true NCSE incidence in cerebral tumors, primary or metastatic cases. Methods: The aim of this study was to compare, retrospectively, four cases of NCSE in both stroke and brain tumors giving emphasis to electrographic sequence at the first and subsequent twelve hours, of treatment, age and prognosis. All patients underwent to continuous EEG from the time of diagnosis to the resolution of seizure activity at the therapy intensive unit from June 2005 to December 2006Results: Eight patients, seven female, were included. The mean age was 67.7 years (range 59 to 79) in stroke patients and 61.5 years (range 34 to 81) in neoplasms cerebral patients. At the first hour of EEG recording, the drugs therapies were benzodiazepines in three patients with stroke, and in all patients with brain tumors and, only one patient with stroke was treated with thiopental, and his EEG showed burst-supression in this time. Two patients with stroke, and three with brain tumors were on adjuvant intravenous therapy (Phenytoin) and four patients (two in both) were on Phenobarbital. At the first hour the ictal pattern in stroke patients were variable, with discrete seizures (DS), continuous ictal discharges (CID) and periodic epileptiform discharges (PED). Among the tumors cases two developed CID, and two were not in electrographical status epilepticus at the first hour of recording. Twelve hours continuous EEG demonstrated a progression to the other types of ictal patterns in three patients with stroke and two patients with brain neoplasms. The two cases remaining showed the same ictal pattern until the end of electrographical status epilepticus. One case relapsed about after 3 days. Three patients died, all of them with prolonged NCSE, two patients out of 4 stroke group and 1 of tumor group. The five patients who survived, all of them presented ictal electrographic pattern lasting less than 120 hours. Conclusions: These data suggest that the ictal patterns change during along the time and the change can not predict the evolution, but the duration of SE can predict the follow up. Stroke and brain tumor showed difference response to the treatment, stroke cases seems to more refractory than brain tumor cases.