Epileptic status – modern concepts about definition, classification, diagnostic criteria and prognostic factors
Keywords:
epileptic status, definition, classification, EEG, diagnostic criteria, predictive factorsAbstract
The recent scientific progress necessitates actualization of some key definitions and classifications in epileptology.
According to the modern definition of epileptic status (ES), proposed by Trinka et al. in 2015, SE is a condition resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms, which lead to abnormally, prolonged seizures. It is a condition, which can have long-term consequences, including neuronal death, neuronal injury, and alteration of neuronal networks, depending on the type and duration of seizures. This definition is conceptual, with two operational dimensions: the first is the length of the seizure and the time point (t1) beyond which the seizure should be regarded as “continuous seizure activity.” The second time point (t2) is the time of ongoing seizure activity after which there is a risk of long-term consequences; this is the time point when a decision about aggressiveness of treatment to prevent from complications should be taken.
The modern classification of ES is based on the so called diagnostic axes: semiology, etiology, EEG correlates and age.
With the purpose of facilitation of diagnosis of non-convulsive ES in medical practice, we present the Modified criteria of Salzburg consensus about non-convulsive ES from 2015. They should be applied in all patients with qualitative or quantitative impairment of consciousness and include typical EEG and clinical data, the combination of which is important for a precise and timely diagnosis.
With the purpose of optimization of strategies for ES coping, we summarize literature data and our experience concerning predictive factors for ES outcome: ES duration, ES etiology, ES type, delayed treatment, focal neurological signs, established epilepsy, delayed diagnosis epilepsy, age, gender, coma/stupor, low sodium level, respiratory depression and prolonged mechanical ventilation, concomitant diseases, abnormal EEG findings.
References
Bauer, G., Trinka, E. Nonconvulsive status epilepticus and coma. Epilepsia, 2010, 51, 177–190.
Beniczky, S., Hirsch, L.J., Kaplan, P.W., Pressler, R., Bauer, G., Aurlien, H., Brøgger, J.C., Trinka, E. Unified EEG terminology and criteria for nonconvulsive status epilepticus. Epilepsia, 2013, 54, 28-29.
Berg, A.T., Berkovic, S.F., Brodie, M.J., Buchhalter, J., Cross, J.H., van Emde Boas, W., Engel, J., French, J., Glauser, T.A., Mathern, G.W., Moshé, S.L., Nordli, D., Plouin, P., Scheffer, I.E. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia, 2010, 51, 676-685.
Blume, W.T., Lüders, H.O., Mizrahi, E., Tassinari, C., Van Emde Boas, W., Engel, J. Glossary of descriptive terminology for ictal semiology: report of the ILAE task force on classification and terminology. Epilepsia, 2001, 42, 1212-1218.
Chen, L., Zhou, B., Li, J.M., Zhu, Y., Wang, J.H., Sander, J.W., Stefan, H., Zhou, D. Clinical features of convulsive status epilepticus; a study of 220 cases in western China. Eur J Neurol, 2009, 164, 4, 444-449.
Dobesberger, J., Ristić, A.J., Walser, G., Kuchukhidze, G., Unterberger, I., Höfler J. Duration of focal complex, secondarily generalized tonic–clonic, and primarily generalized tonic-clonic seizures - a video-EEG analysis. Epilepsy Behav, 2015, 49, 111–117.
Drislane, F.W., Blum, A.S., Lopez, M.R., Gautam, S., Schomer, D.L. Duration of refractory status epilepticus and outcome: loss of prognostic utility after several hours. Epilepsia, 2009, 50, 6, 1566-1571.
Engel, J. Jr., International League Against Epilepsy (ILAE). A proposed diagnostic scheme for people with epileptic seizures and with epilepsy: report of the ILAE Task Force on Classification and Terminology. Epilepsia, 2001, 42, 796-803.
Hesdorffer, D.C., Benn, E.K., Bagiella, E., Nordli, D., Pellock, J., Hinton, V., Shinnar, S. and for the FEBSTAT Study Team. Distribution of febrile seizure duration and associations with development. Ann Neurol, 2011, 70, 93-100.
Hirsch, L.J., LaRoche, S.M., Gaspard, N., Gerard, E., Svoronos, A., Herman, S.T., Mani, R., Haider, H., Jette, N., Minazad, Y., Kerrigan, J., Vespa, P., Hantus, S., Claassen, J., Young, G., So, E., Kaplan, P., Nuwer, M., Fountain, N., Drislane, F. American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology: 2012 version. J Clin Neurophysiol, 2013, 30, 1-27.
Hocker, S.E., Britton, J.W., Mandrekar, J.N., Wijdicks, E.F., Rabinstein, A.A. Predictors of outcome in refractory status epilepticus. JAMA Neurol, 2013, 70, 1, 72-77.
Holtkamp, M., Othman, J., Buchheim, K., Masuhr, F., Meierkord, H. A “malignant” variant of status epilepticus. Arch Neurol, 2005, 62, 9, 1428-1431.
Holtkamp, M., Othman, J., Buchheim, K., Meierkord, H. Predictors and prognosis of refractory status epilepticus in a neurological intensive care unit. J Neurol Neurosurg Psychiatry, 2005, 76, 4, 534-539.
Hui, A.C., Joynt, G.M., Li, H., Wong, K.S. Status epilepticus in Hong Kong Chinese: aetiology, outcome and predictors of death and morbidity. Seizure, 2003, 12, 7, 478-482.
Hui, A.C., Lam, A.K., Wong, A., Chow, K.M., Chan, E.L., Choi, S.L., Wong, K.S. Generalized tonic-clonic status epilepticus in the elderly in China. Epileptic Disord, 2005, 7, 1, 27-31.
Joyalakshmi, S., Ruikar, D., Vootury, S., Alladi, S., Sahu, S., Kaul, S., Mohandas, S. Determinants and predictors of outcome in super refractory status epilepticus-A developing country perspective. Epilepsy Res, 2014, 108, 9, 1609-1617.
Kang, B.S., Jhang, Y., Kim, Y.S., Moon, J., Shin, J.W., Moon, H.J., Lee, S.T., Jung, K.H., Chu, K., Park, K.I., Lee S.K. Etiology and prognosis of non-convulsive status epilepticus. J Clin Neurosci, 2014, 21, 11, 1915-1919.
Koubeissi, M., Alshekhlee, A. In-hospital mortality of generalized convulsive status epilepticus: a large US sample. Neurology, 2007, 69, 9, 886-893.
Kravljanac, R., Jovic, N., Djuric, N., Jankovic, B., Pekmezovic, T. Outcome of status epilepticus in children treated in the intensive care unit: a study of 302 cases. Epilepsia, 2011, 52, 2, 358-363.
Kumar, M., Kumari, R., Narain, N.P. Clinical Profile of Status Epilepticus (SE) in Children in a Tertiary Care Hospital in Bihar. J Clin Diagn Res, 2014, 8, 7, PC14-PC17.
Lambrechtsen, F.A., Buchhalter, J.R. Aborted and refractory status epilepticus in children: a comparative analysis. Epilepsia, 2008, 49, 4, 615-625.
Leitinger, M., Beniczky, S., Rohracher, A., Gardella, E., Kalss, G., Qerama, E., Höfler, J., Hess Lindberg-Larsen, A., Kuchukhidze, G., Dobesberger, J., Langthaler, P.B., Trinka, E. Salzburg Consensus Criteria for Non-Convulsive Status Epilepticus - approach to clinical application. Epilepsy Behav, 2015, 49, 158-163.
Murthy, J.M., Joyalaxmi, S.S., Kanikannan, M.A. Convulsive status epilepticus: clinical profile in a developing country. Epilepsia, 2007, 48, 12, 2217-2223.
Novy, J., Logroscino, G., Rossetti, A.O. Refractory status epilepticus: a prospective observational study. Epilepsia, 2010, 51, 2: 251-256.
Rocco, M., Caputo, C., Fegiz, A., Maggi, L., De Blasi, R.A. Status epilepticus in critically ill patients. EMJ Neurol, 2015, 3, 1, 96-106.
Rossetti, A.O., Hurwitz, S., Logroscino, G., Bromfield, E.B. Prognosis of status epilepticus: role of aetiology, age, and consciousness impairment at presentation. J Neurol, Neurosurg, Psychiatry, 2006, 77, 5, 611-615.
Sagduyu, A., Tarlaci, S., Sirin, H. Generalized tonic-clonic status epilepticus: causes, treatment, complications and predictors of case fatality. Neurol, 1998, 245, 10, 640-646.
Santamarina, E., Gonzalez, M., Toledo, M., Sueiras, M., Guzman, L., Rodríguez, N., Quintana, M., Mazuela, G., Salas-Puig, X. Prognosis of status epilepticus (SE): Relationship between SE duration and subsequent development of epilepsy. Epilepsy Behav, 2015, 49, 138-140.
Shorvon, S. Clinical forms of status epilepticus. In: Shorvon S (Ed) Status epilepticus. Ist clinical features and treatment in children and adults. Cambridge - United Kingdom, Cambridge University Press, 1994, 34–137.
Sutter, R., Kaplan, P.W. Electroencephalographic criteria for nonconvulsive status epilepticus: synopsis and comprehensive survey. Epilepsia, 2012, 53, Suppl. 3, 1-51.
Tiamkao, S., Pranboon, S., Thepsuthammarat, K., Sawanyawisuth, K. Incidences and outcomes of status epilepticus: A 9-year longitudinal national study. Epilepsy Behav, 2015, 49, 135-137.
Towne, A.R. Epidemiology and outcomes of status epilepticus in the elderly. Int Rev Neurobiol, 2007, 81, 111-127.
Trinka, E., Cock, H., Hesdorffer, D., Rossetti, A., Scheffer, I., Shinnar, S., Shorvon, S., Lowenstein, D. A definition and classification of status epilepticus – Report of the ILAE Task Force on classification of status epilepticus. Epilepsia, 2015, 56, 10, 1-9.
Tsetsou, S., Novy, J., Rossetti, A.O. Recurrence of status epilepticus: Prognostic role and outcome predictors. Epilepsia, 2015, 56, 3, 473-478.
Viteva, E., Chaneva, O. Predictors of status epilepticus duration and short-term outcome in Bulgarian patients treated in a neuro-intensive care unit Merit Research Journal of Medicine and Medical Sciences (MRJMMS), 2015, 3, 4, 158-164.
Vooturi, S., Jayalakshmi, S., Sahu, S., Mohandas, S. Prognosis and predictors of outcome of refractory generalized convulsive status epilepticus in adults treated in neurointensive care unit. Clin Neurol Neurosurg, 2014, 126, 7-10.
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