Abstracts

Rationale: Nonconvulsive status epilepticus (NCSE) is an often unrecognized condition that can lead to significant morbidity and mortality and the incidence is not well known. Multiple studies have identified first and second-line therapies for status epilepticus (SE) however, for NCSE, treatment regimens and use of sedation become less well defined. Patient outcomes from SE /NCSE vary highly based on the underlying etiology, with hypoxic injury and brain tumors carrying a worse prognosis. We wish to compare our cohort of NCSE patients utilizing known data regarding etiology, medical treatment, and clinical outcomes, to assess if our patient population differs from the current literature. Methods: A retrospective chart review was performed between 2009 and 2013. Patient records were reviewed if they contained a diagnosis code for status epilepticus, CPT code for video-EEG monitoring, and were admitted into an intensive care unit. Patients between 10 and 110 years were included. The diagnosis of NCSE was made utilizing routine and/or continuous video electroencephalogram and patients whose etiology was hypoxic-ischemic brain injury were excluded.Results: Fifty-six charts reviewed and 23 cases which met the above criteria were identified. There were 9 men and 14 women whose average age was 54 years. Thirty percent presented after one or more generalized tonic-clonic or tonic seizures. Forty-eight percent presented with mild to moderate impairment of consciousness. Twenty-two percent had moderate to severe impairment of consciousness. Thirty-five percent presented with subtle motor movements. Twenty-two percent had forced eye deviation or gaze preference. Focal nonconvulsive SE (fNCSE) accounted for 74% of the cases and generalized nonconvulsive status epilepticus (gNCSE) accounted for 13%. Patients with fNCSE had and average hospital stay of 19.2d, ICU stay of 11.1d and 6.1d spent on c-VEEG. fNCSE patients were treated with an average of 2.6 AEDs and, if treated with anesthesia, were sedated for an average of 4.6d. Patients with gNCSE had an average hospital stay of 45.7d, 20.7d in an ICU, and 8d of c-VEEG monitoring. The gNCSE group was treated with an average of 3 AEDs and 7.5d of sedation. Most common etiologies in the fNCSE group included meningoencephalitis, history of epilepsy, and remote stroke. In the gNCSE group, 2 patients were diagnosed with Creutzfeld-Jacob disease (CJD) and one with severe sepsis. First line IV-AEDs for 78% was fosphenytoin and propofol was used for general anesthesia in 73%. There was 100% mortality in the gNCSE group and 41% in the fNCSE group. Cognitive impairment was seen in patients whose fNCSE lasted >24 hours. Conclusions: Our data demonstrates worse outcomes in gNCSE and if underlying etiology is CJD. NCSE with a history of epilepsy portends a better outcome. Longer duration of uncontrolled fNCSE may lead to adverse cognitive impact. Outcomes are worse when a patient in NCSE is diagnosed with sepsis.