Abstracts

Rationale: Previous studies at our institution suggested high prevalence rates for status epilepticus (SE) and poor prognosis in patients undergoing CEEG. We sought to determine prognostic factors in patients with status epilepticus undergoing CEEG. Methods: Patients with altered mental status (AMS) undergoing CEEG for at least 24 hours in 2005 at this institution were retrospectively reviewed. EEG results, diagnoses, imaging studies and outcomes were analyzed. Results: The most common indication for CEEG was witnessed seizure and/or AMS. The duration of CEEG monitoring ranged from 1 to 16 days with a mean of 4.35 days. 20 patients (65%) had seizures captured on first routine (30-minute) EEG. Of the 31 patients monitored, 25 (81%) had SE. In 23 of the patients, SE was captured on CEEG, while the remaining 2 patients had observed convulsive SE prior to EEG. 22 (71%) of our 31 patients monitored had clinical seizure activity prior to the CEEG. Of the patients who had SE, 8 (32%) had prior history of seizures or epilepsy. 6 (75%) of those had NCSE, 1 had mixed presentation, and 1 had observed convulsive SE only (no SE captured on EEG). In our group without history of seizures, 6 (35%) had NCSE, 7 (41%) had mixed presentation, 3 (18%) had clinical SE on EEG, and 1 (6%) had observed convulsive SE only. 13 patients (41%) had evidence of acute brain injury (ABI), defined as acute abnormality on brain imaging within 7 days of SE, and 92% of those with ABI had SE. 7 of the 13 ABI patients (54%) had subarachnoid hemorrhage, subdural hematoma, or both. Of those with ABI and SE, mortality was 75%. 8 patients (25%) were coded within 7 days of SE, and all of them died except 1 patient with respiratory arrest and opiate-induced SE. 16 (64%) of the total patients with SE died, including 14 (56%) who died with comfort care measures in place. 5 of 8 (63%) patients with SE and history of seizures were alive at hospital discharge, but only 4 of 17 (24%) patients without seizure history survived to discharge. Conclusions: Status epilepticus occurred with high prevalence in this group and may be due to occurrence of seizures prior to EEG. NCSE was frequently seen, especially in those with prior history of epilepsy. Mortality and prevalence of SE was notably high in patients with acute hemorrhagic insults. Patients with SE and no prior seizure history had higher mortality.