Bilateral Tonic Seizures vs Bilateral Tonic Events in Critically IIl Patients
Abstract number :
1.144
Submission category :
3. Neurophysiology / 3A. Video EEG Epilepsy-Monitoring
Year :
2021
Submission ID :
1826369
Source :
www.aesnet.org
Presentation date :
12/4/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:53 AM
Authors :
Roohi Katyal, MD - University of Maryland Medical Center; Guadalupe Fernandez-Baca Vaca, MD - Epilepsy Center Director, University Hospitals Cleveland Medical Center; Michael DeGeorgia, MD - University Hospitals Cleveland Medical Center; Hans Lüders, MD - University Hospitals Cleveland Medical Center
Rationale: Our primary aim was to analyze bilateral epileptic tonic seizures (ETS) and bilateral non-epileptic tonic events (NTE) in critically ill patients in order to help clinically differentiate between the two and facilitate work-up and treatment. Our secondary aim was to analyze ETS per their epileptogenic zone.
Methods: We included consecutive patients with ETS in the Epilepsy Monitoring Unit (EMU) from January 2010 to January 2021 and consecutive patients with documented NTE in the Intensive Care Unit (ICU) between January 2017 and January 2021. We then performed a retrospective descriptive analysis after reviewing 34 videos of ETS in 34 patients and 16 videos of NTE in 15 patients. Two authors (R.K. and G.F.) independently reviewed and classified the semiology of these paroxysms.
Results: Figures 1 and 2 show the main results. Compared to patients with ETS, those with NTE more frequently had predominant involvement of proximal upper extremities (UE) (69% vs 21%), internal rotation of UE (69% vs 3%), adduction of UE (81% vs 6%) and bilateral elbow extension (75% vs. 6%). In contrast, compared to patients with NTE, those with ETS more frequently had abduction of UE (82% vs 0%), the elevation of UE (91% vs 37%), open eyelids (73% vs 19%), and involvement of both proximal and distal UE (79% vs 31%). Notably, 47% of ETS patients had either trunk flexion or extension whereas trunk position was neutral in 94% of NTE patients. In patients with ETS, the epileptogenic zone was generalized in 47%, focal in 47%, and undetermined in 6%. Synchronous onset was more frequently seen in generalized onset seizures than in focal onset seizures (87% vs 63%). In addition, seizures that remained symmetrical throughout were more likely to have a generalized onset than focal (38% vs 6%), whereas, seizures that were asymmetrical were more likely focal in onset (94% vs 62%).
Conclusions: A careful analysis of semiology can help differentiate between ETS and NTE in the ICU. NTE are typically characterized by adduction, internal rotation, and extension of proximal upper extremities along with minimal elevation if any. ETS, on the other hand, are typically characterized by involvement of both proximal and distal body parts with abduction and elevation of upper extremities. Compared to generalized onset tonic seizures, focal seizures are more likely to be asynchronous and asymmetrical.
Funding: Please list any funding that was received in support of this abstract.: None.
Neurophysiology