Abstracts

Rationale: A major effort of the past decade has been to better understand non-convulsive status epilepticus (NCSE). Convulsive status epilepticus (CSE) is known to be life-threatening, with a potential for worsened outcome depending on etiology, age, and time to treatment. In this study, we have retrospectively identified all cases of NCSE at a tertiary hospital in the year 2006, categorizing NCSE and outcome.Methods: This study is a retrospective case series. In it, NCSE is defined as 1) a change in mental status without concurrent convulsions, and 2) electrographic seizures on the electroencephalogram (EEG). Outcome is determined by level of care needed on admission vs. discharge, with four possible endpoint scores (ES’s) given, from 0 to 3: 0=return to baseline; 1=temporary increase in level of care from baseline (i.e., from home to rehabilitation); 2=permanent increase in care (i.e., from home to nursing home); or 3=death. The study is stratified by two known complicating factors in NCSE: age (younger or equal to 65 years old vs. older than 65) and level of consciousness at the time of EEG (altered metal status vs. comatose). Other variables documented include medications (time started, dosages, and serum concentrations), etiology of NCSE, and complications/comorbidities.Results: Fifty-five cases were identified. To date, 22 of the 28 patients qualified, and of these, ten patients were treated within the first hour (“Early Treatment Group”, or ETG), while the remaining twelve were treated after one hour (“Late Treatment Group”, or LTG). Overall, those in the ETG had a mean ES of 1.2, while in the LTG, it was 1.5, showing a 20% improvement in outcome for those treated earlier. If stratified based on age, the ETG’s mean ES was 1.0 for younger patients, and 1.67 for seniors. The LTG showed a mean ES of 1.17 for younger patients, and 1.83 for older patients. When stratified based on level of consciousness, the ETG had a mean ES of 0.57 if not in coma vs. a striking 2.67 if comatose. The LTG showed similar results, with a mean ES of 1.0 in the non-comatose vs. a mean ES of 2.2 in those with coma.Conclusions: The preliminary data of this study suggest that earlier treatment for NCSE, if started within the first hour of onset, might improve outcome. Stratification based on age and level of consciousness improves outcome for the young and the non-comatose, and worsens it for seniors and especially those in a coma. This latter group’s outcome is likely complicated by a more severe underlying etiology. To that end, our own analysis of etiology – as well as aggressiveness of AED dosing, and subtypes of NCSE -- will be presented. This study encourages a continuing refinement in our ability to diagnose – quickly -- who has NCSE and who has a “mimicker” (a post-ictal state, toxic-metabolic encephalopathy, etc.).