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Status Epilepticus in Adults

  • Fabio MinicucciEmail author
  • Matteo Impellizzeri
  • Giovanna Fanelli
Chapter

Abstract

In electroencephalography books, relative significance is given to “status epilepticus” (SE), maybe because of the idea that it could only be a simple repetition of seizures in a very short time from one another. Actually, at least two factors contribute making the EEG patterns of SE much more complex: the first is the overlapping of the transients related to the seizures with those related to underlying disease, and the second is the EEG modification related to a sustained or prolonged status epilepticus. The EEG of the SE can thus follow its graphic expression which is different from that of single seizures repeated over time, coming up to express critical patterns that are not always easily recognizable. The elements of pathophysiology and clinical electroencephalographic practice show that the SE is a dynamic pathological process that expresses itself in a different manner from patient to patient depending on its etiology, duration, topographic extension, clinical manifestation, and therapeutic interventions that are carried out. The proposed classification of SE in 2015 (Trinka et al., Epilepsia 56(10):1515–23, 2015) establishes the importance of EEG in the diagnosis and management of the SE by including the EEG axial description to define a correct classification of the patient.

Keywords

Status epilepticus EEG Nonconvulsive status epilepticus (NCSE) Ictal-interictal continuum 

Notes

Acknowledgments

A special thanks to the EEG technicians of San Raffaele Hospital of Milan, Alessandra Amato, Sara Bruno, Aldo Elia, Claudia Paleari, and Amelia Tirelli, for the competence in carrying out of the exams. We also mentioned Laura Schieppati e Lucrezia Nava for English translation of the text and Marco Vabanesi and Marco Cursi for the relevant contribution to the activity of our laboratory.

References

  1. 1.
    Hesdorffer DC, Logroscino G, Cascino G, et al. Incidence of status epilepticus in Rochester, Minnesota, 1965–1984. Neurology. 1998;50(3):735–41.PubMedCrossRefGoogle Scholar
  2. 2.
    Coeytaux A, Jallon P, Galobardes B. Incidence of status epilepticus in French-speaking Switzerland: (EPISTAR). Neurology. 2000;55(5):693–7.PubMedCrossRefGoogle Scholar
  3. 3.
    DeLorenzo RJ, Pellock JM, Towne AR, et al. Epidemiology of status epilepticus. J Clin Neurophysiol. 1996;13(5):458.CrossRefGoogle Scholar
  4. 4.
    Knake S, Rosenow F, Vescovi M, et al. Incidence of status epilepticus in adults in Germany: a prospective, population-based study. Status Epilepticus Study Group Hessen (SESGH). Epilepsia. 2001;42(6):714–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Vignatelli L, Tonon C, D’Alessandro R. Bologna Group for the Study of Status Epilepticus. Incidence and short-term prognosis of status epilepticus in adults in Bologna, Italy. Epilepsia. 2003;44(7):964–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Waterhouse EJ, DeLorenzo RJ. Status epilepticus in older patients: epidemiology and treatment options. Drugs Aging. 2001;18(2):133–42.PubMedCrossRefGoogle Scholar
  7. 7.
    Hauser WA. Status epilepticus: epidemiologic considerations. Neurology. 1990;40(5 Suppl 2):9–13.PubMedGoogle Scholar
  8. 8.
    Towne AR, Pellock JM, Ko D, et al. Determinants of mortality in status epilepticus. Epilepsia. 1994;35:27–34.PubMedCrossRefGoogle Scholar
  9. 9.
    Shneker BF, Fountain NB. Assessment of acute morbidity and mortality in non status epilepticus. Neurology. 2003;61:1066–73.PubMedCrossRefGoogle Scholar
  10. 10.
    Rossetti AO, Logroscino G, Bromfield EB. A clinical score for prognosis of status epilepticus in adult. Neurology. 2006;66:1736–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Aminoff MJ, Simon RP. Status epilepticus. Causes, clinical features and consequences in 98 patients. Am J Med. 1980;69(5):657–66.PubMedCrossRefGoogle Scholar
  12. 12.
    Tan RY, Neligan A, Shorvon SD. The uncommon causes of status epilepticus. Epilepsy Res. 2010;91:111–22.PubMedCrossRefGoogle Scholar
  13. 13.
    Dobesberger J, Ristić AJ, Walser G, et al. Duration of focal complex, secondarily generalized tonic–clonic, and primarily generalized tonic–clonic seizures: a video-EEG analysis. Epilepsy Behav. 2015;49:111–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Treatment of convulsive status epilepticus. Recommendations of the epilepsy foundation of America’s working group on status epilepticus. JAMA. 1993;270(7):854–9.Google Scholar
  15. 15.
    Trinka E, Cock H, Hesdorffer D, et al. A definition and classification of status epilepticus – report of the ILAE task force on classification of status Epilepticus. Epilepsia. 2015;56(10):1515–23.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Gastaut H, Tassinari C. Status epilepticus. In: Redmond A, editor. Handbook of electroencephalography and clinical neurophysiology, vol. 13. Amsterdam: Elsevier; 1975. p. 39–45.Google Scholar
  17. 17.
    Shorvon S. Status epilepticus: its clinical features and treatment in children and adults. Cambridge: Cambridge University Press; 1994.CrossRefGoogle Scholar
  18. 18.
    Treiman DM, Walton NY, Kendrick C. A progressive sequence of electroencephalographic changes during generalised convulsive status epilepticus. Epilepsy Res. 1990;5:49–60.PubMedCrossRefGoogle Scholar
  19. 19.
    Lothman EW. The biochemical basis and pathophysiology of status epilepticus. Neurology. 1990;40(Supp1 2):13–23.PubMedGoogle Scholar
  20. 20.
    Florea B, Beniczky SA, Demény H. Semiology of subtle motor phenomena in critically ill patients. Seizure. 2017;48:33–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Kobayashi E, Thomas P, Andermann F. Tonic status epilepticus in patients with idiopathic generalized epilepsy. Epileptic Disord. 2005;7(4):327–31.PubMedGoogle Scholar
  22. 22.
    Mameniškienė R, Wolf P. Epilepsia partialis continua: a review. Seizure. 2017;44:74–80.PubMedCrossRefGoogle Scholar
  23. 23.
    Gastaut H. Aphasia: the sole manifestation of focal status epilepticus. Neurology. 1979;29(12):1638.PubMedCrossRefGoogle Scholar
  24. 24.
    Wells CR, Labar DR, Solomon GE. Aphasia as the sole manifestation of simple partial status epilepticus. Epilepsia. 1992;33(1):84–7.PubMedCrossRefGoogle Scholar
  25. 25.
    DeToledo JC, Minagar A, Lowe MR. Persisting aphasia as the sole manifestation of partial status epilepticus. Clin Neurol Neurosurg. 2000;102(3):144–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Thomas P, Kullmann B, Chatel M. Status epilepticus with aphasic manifestation. Rev Neurol. 1991;147(3):246–50.PubMedGoogle Scholar
  27. 27.
    Grimes DA, Guberman A. De novo aphasic status epilepticus. Epilepsia. 1997;38(8):945–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Herskovitz M, Schiller Y. Prolonged ictal aphasia: a diagnosis to consider. J Clin Neurosci. 2012;19(11):1605–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Takaya S, Matsumoto R, Namiki C, et al. Frontal nonconvulsive status epilepticus manifesting somatic hallucinations. J Neurol Sci. 2005;234(1–2):25–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Tiamkao S, Pratipanawatr T, Jitpimolmard S. Abdominal epilepsy: an uncommon of non-convulsive status epilepticus. J Med Assoc Thai. 2011;94(8):998–1001.PubMedGoogle Scholar
  31. 31.
    Kaplan P. EEG criteria for nonconvulsive status epilepticus. Epilepsia. 2007;48(Suppl 8):39–41.PubMedCrossRefGoogle Scholar
  32. 32.
    Treiman DM, Delgado-Escueta AV. Complex partial status epilepticus. Adv Neurol. 1983;34:69–81.PubMedGoogle Scholar
  33. 33.
    Granner MA, Lee S. Nonconvulsive status epilepticus: EEG annalysis in a large series. Epilepsia. 1994;35:42–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Young GB, Jordan KG, Doig GS. An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology. 1996;47:83–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Chong DJ, Hirsch LJ. Which EEG patterns warrant treatment in the critically ill? Reviewing the evidence for treatment of periodic epileptiform discharges and related patterns. Clin Neurophysiol. 2005;22(2):79–91.CrossRefGoogle Scholar
  36. 36.
    Sutter R, Kaplan PW. Electroencephalographic criteria for nonconvulsive status epilepticus: synopsis and comprehensive survey. Epilepsia. 2012;53(Suppl 3):1–51.PubMedCrossRefGoogle Scholar
  37. 37.
    Beniczky S, Hirsch LJ, Kaplan PW, et al. Unified EEG terminology and criteria for nonconvulsive status epilepticus. Epilepsia. 2013;54(Suppl 6):28–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Leitinger M, Beniczky S, Rohracher A, et al. Salzburg consensus criteria for non-convulsive status epilepticus: approach to clinical application. Epilepsy Behav. 2015;49:158–63.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Leitinger M, Trinka E, et al. Diagnostic accuracy of the Salzburg EEG criteria for non-convulsive status epilepticus: a retrospective study. Lancet Neurol. 2016;15:1054–62.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Walker M, Cross H, Smith S, et al. Nonconvulsive status epilepticus: Epilepsy Research Foundation workshop reports. Epileptic Disord. 2005;7(3):253–96.PubMedGoogle Scholar
  41. 41.
    Hirsch LJ, Brenner RP, Drislane FW, et al. The ACNS subcommittee on research terminology for continuous EEG monitoring: proposed standardized terminology for rhythmic and periodic EEG patterns encountered in critically ill patients. J Clin Neurophysiol. 2005;22:128–35.PubMedCrossRefGoogle Scholar
  42. 42.
    Trinka E, Leitinger M. Which EEG patterns in coma are nonconvulsive status epilepticus? Epilepsy Behav. 2015;49:203–22.PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Brigo F. Intermittent rhythmic delta activity patterns. Epilepsy Behav. 2011;20:254–6.PubMedCrossRefGoogle Scholar
  44. 44.
    Gaspard N, Manganas L, Rampal N. Similarity of lateralized rhythmic delta activity to periodic lateralized epileptiform discharges in critically ill patients. JAMA Neurol. 2013;70(10):1288–95.PubMedGoogle Scholar
  45. 45.
    Rodriguez Ruiz A, Vlachy J, Lee JW, et al. Association of periodic and rhythmic electroencephalographic patterns with seizures in critically ill patients. JAMA Neurol. 2017;74(2):181–8.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Van Putten MJ, Hofmeijer J. Generalized periodic discharges: pathophysiology and clinical considerations. Epilepsy Behav. 2015;49:228–33.PubMedCrossRefGoogle Scholar
  47. 47.
    Bremer F. Considérations sur l’origine et la nature des ondes cérébrales. Electroencephalogr Clin Neurophysiol. 1949;1(2):177–93.PubMedGoogle Scholar
  48. 48.
    Chatrian GE, Shaw CM, Leffman H. The significance of periodic lateralized epileptiform discharges in EEG: an electrographic, clinical and pathological study. Electroencephalogr Clin Neurophysiol. 1964;17:177–93.PubMedCrossRefGoogle Scholar
  49. 49.
    Brenner RP, Schaul N. Periodic EEG patterns: classification, clinical correlation, and pathophysiology. J Clin Neurophysiol. 1990;7(2):249–67.PubMedCrossRefGoogle Scholar
  50. 50.
    Snodgrass SM, Tsuburaya K, Ajmone-Marsan C. Clinical significance of periodic lateralized epileptiform discharges: relationship with status epilepticus. J Clin Neurophysiol. 1989;6(2):159–72.PubMedCrossRefGoogle Scholar
  51. 51.
    Raroque HG Jr, Purdy P. Lesion localization in periodic lateralized epileptiform discharges: gray or white matter. Epilepsia. 1995;36(1):58–62.PubMedCrossRefGoogle Scholar
  52. 52.
    Gurer G, Yemisci M, Saygi S, et al. Structural lesions in periodic lateralized epileptiform discharges (PLEDs). Clin EEG Neurosci. 2004;35(2):88–93.PubMedCrossRefGoogle Scholar
  53. 53.
    Pohlmann-Eden B, Hoch DB, Cochius JI, et al. Periodic lateralized epileptiform discharges a critical review. J Clin Neurophysiol. 1996;13(6):519–30.PubMedCrossRefGoogle Scholar
  54. 54.
    Baykan B, Kinay D, Gokyigit A, et al. Periodic lateralized epileptiform discharges: association with seizures. Seizure. 2000;9(6):402–6.PubMedCrossRefGoogle Scholar
  55. 55.
    Assal F, Papazyan JP, Slosman DO, et al. SPECT in periodic lateralized epileptiform discharges (PLEDs): a form of partial status epilepticus? Seizure. 2001;10(4):260–5.PubMedCrossRefGoogle Scholar
  56. 56.
    Garzon E, Femandes RM, Sakamoto AC. Serial EEG during human status epilepticus: evidence for PLEDs as an ictal pattern. Neurology. 2001;57(7):1175–83.PubMedCrossRefGoogle Scholar
  57. 57.
    Reiher J, Rivest J, Grand’Maison F, et al. Periodic lateralized epileptiform discharges with transitional rhythmic discharges: association with seizures. Electroencephalogr Clin Neurophysiol. 1991;78(1):12–7.PubMedCrossRefGoogle Scholar
  58. 58.
    De la Paz D, Brenner RR. Bilateral independent periodic lateralized epileptic discharges. Arch Neurol. 1981;38:713–5.PubMedCrossRefGoogle Scholar
  59. 59.
    Schwartz MS, Prior PF, Scott DF. The occurrence and evolution in the EEG of a lateralized periodic phenomenon. Brain. 1973;96(3):613–22.PubMedCrossRefGoogle Scholar
  60. 60.
    Cobb WA, Hill D. Electroencephalogram in subacute progressive encephalitis. Brain. 1950;73(3):392–404.PubMedCrossRefGoogle Scholar
  61. 61.
    Alajouanine T, Nehlil J. Clinical and electroencephalographic verification of a probable case of subacute sclerosing leukoencephalitis. Rev Neurol. 1955;93(2):435–7.PubMedGoogle Scholar
  62. 62.
    Kaya D, Bingol CA. Significance of atypical triphasic waves for diagnosing nonconvulsive status epilepticus. Epilepsy Behav. 2007;11(4):567–77.PubMedCrossRefGoogle Scholar
  63. 63.
    Boulanger JM, Deacon C, Lecuyer D, et al. Triphasic waves versus nonconvulsive status epilepticus: EEG distinction. Can J Neurol Sci. 2006;33(2):175–80.PubMedCrossRefGoogle Scholar
  64. 64.
    Hirsch LJ, Claassen J, Mayer SA, et al. Stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs): a common EEG phenomenon in the critically ill. Epilepsia. 2004;45(2):109–23.PubMedCrossRefGoogle Scholar
  65. 65.
    Hirsch LJ, Pang T, Claassen J, et al. Focal motor seizures induced by alerting stimuli in critically ill patients. Epilepsia. 2008;49(6):968–73.PubMedCrossRefGoogle Scholar
  66. 66.
    Zaret BS. Prognostic and neurophysiological implications of concurrent burst suppression and alpha patterns in the EEG of post-anoxic coma. Electroencephalogr Clin Neurophysiol. 1985;61(4):199–209.PubMedCrossRefGoogle Scholar
  67. 67.
    Trinka EHJ. EEG in coma and brain death. Clin Neurophysiol. 2011;42(3):141–8.Google Scholar
  68. 68.
    DeLorenzo RJ, Waterhouse EJ, Towne AR, et al. Persistent non-convulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia. 1998;39(8):833–40.PubMedCrossRefGoogle Scholar
  69. 69.
    Krishnamurthy KB, Drislane FW. Depth of EEG suppression and outcome in barbiturate anesthetic treatment for refractory status epilepticus. Epilepsia. 1999;40(6):759–62.PubMedCrossRefGoogle Scholar
  70. 70.
    Brenner RP. How useful is EEG and EEG monitoring in the acutely ill and how to interpret it? Epilepsia. 2009;50(Suppl 12):34–7.PubMedCrossRefGoogle Scholar
  71. 71.
    Kaplan PW. Assessing the outcomes in patients with nonconvulsive status epilepticus: nonconvulsive status epilepticus is under-diagnosed, potentially overtreated, and confounded by comorbidity. J Clin Neurophysiol. 1999;16(4):341–52.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Fabio Minicucci
    • 1
    Email author
  • Matteo Impellizzeri
    • 2
  • Giovanna Fanelli
    • 2
  1. 1.Department of NeurologyChief of Epilepsy Center, Ospedale San RaffaeleMilanItaly
  2. 2.Department of NeurologyOspedale San RaffaeleMilanItaly

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