Abstracts

RATIONALE: The electroencephalographic (EEG) hallmark of status epilepticus (SE) is continuous spike and wave activity or electrographic seizures recurring at frequent intervals. External stimulation has not been reported to have an affect on this EEG activity. This study was done to describe patients in whom SE was triggered by external stimulation. At the end of this activity, participants should appreciate the presence of stimulus sensitive SE.
METHODS: All patients undergoing prolonged EEG monitoring for SE by the Duke EEG Laboratory between July 1999 and May 2002 were reviewed. Patients were enrolled if external stimulation (i.e. pinching, suctioning, etc.) resulted in the EEG changing from a nonepileptic pattern to continuous spike and wave activity. The clinical characteristics of these patients were noted.
RESULTS: Three patients were identified who met criteria for enrollment. The mean age was 32.3 years; all were females. SE represented the first seizures for all. They were being treated for SE with multiple antiepileptic drugs (AEDs) and anesthetics. Prior to stimulation, the patients[scquote] EEG consisted of either a burst-suppression pattern or generalized periodic epileptiform discharges (GPEDs). With stimulation this, the EEG evolved into rhythmic, continuous spike and wave activity that lasted from several seconds to minutes. Two patients survived, one was transferred to a rehabilitation facility. One patient died.
CONCLUSIONS: Stimulus sensitive SE may be seen in patients who appear to be in burst suppression with AEDs and anesthetics medications. Patients in induced burst suppression for SE should be tested with stimulation to confirm adequate treatment.