The Electroencephalographic Response to Benzodiazepines Is a Predictor of Outcome in Patients with Suspected Nonconvulsive Status Epilepticus.
Abstract number :
2.138
Submission category :
Year :
2001
Submission ID :
1186
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
S.I. Shaukat, MBBS, Neurology, University of Maryland Medical School, Baltimore, MD; A. Krumholz, MD, Neurology, University of Maryland Medical School, Baltimore, MD; G. Hart, MD, Neurology, University of Maryland Medical School, Baltimore, MD; L.G. Seide
RATIONALE: Nonconvulsive status epilepticus (NCSE) is an epileptiform encephalopathy that benefits from antiepileptic drug treatment but is difficult to distinguish from other such encephalopathies that do not. We investigated the value of electroencephalographic (EEG) patterns and responses to intravenous administration of benzodiazepines (BDZs) for predicting outcome and guiding management in individuals with suspected NCSE.
METHODS: We studied all patients with suspected NCSE referred to the University of Maryland Epilepsy Center. Initially, the review was retrospective, but more recently it has been prospective. In addition to other antiepileptic drug therapy, patients with suspected NCSE based on clinical presentation and an epileptiform EEG received an intravenous BDZ at a dose sufficient to abolish or substantially reduce the abnormal EEG pattern or at the maximal tolerated dose. The relations of outcomes such as survival, recovery of consciousness, and functional status at discharge to the EEG patterns and responses to BDZ administration were evaluated.
RESULTS: From 1988 to 1998, 62 patients with suspected NCSE were retrospectively identified. Twenty two (35%) of these patients exhibited a clinical response, defined as improvement in level of consciousness, to BDZ administration, whereas 40 subjects (65%) were clinical nonresponders. A positive clinical response was predictive of outcome and survival (p less than 0.05) Fifty three (85%) of all patients exhibited a partial or complete EEG response to BDZs, and 9 (15%) patients were EEG nonresponders. A positive EEG response was predictive of recovery of consciousness and functional recovery (p less than 0.05), but not of survival. There was a trend towards better survival for those with complete as compared to partial EEG responses to BDZs. Since 1999 we have been identifying patients prospectively, and observe similar findings. We have also found that specific EEG patterns are predictive of outcome.
CONCLUSIONS: Electroencephalographic (EEG) responses to BDZ administration are of value for predicting outcome and guiding therapy in patients with suspected NCSE. However, EEG responses are not as good predictors of outcome as are clinical responses to BDZs. Electroencephalographic and clinical responses to BDZs merit inclusion as criteria in operational definitions of NCSE.
Support: Rosen Fund for Neurological Research