Abstracts

Rationale: Previous investigations of status epilepticus (SE) reported frequent occurrences of SE- related reversible abnormalities in Neuroimaging as well as diverse peri-ictal EEG abnormalities (PEA) including electrical seizures (ESz), ictal-interictal continuum (IIC) or lateralized rhythmic delta activities (LRD). However, their relationship to the semiology of SE have not been properly studied yet. The aim of this study was to investigate the relationships of electroclinical variables including PMA and PEA with the semiology of SE; NCSE and CSE.


Methods: We conducted a retrospective systemic review of our Hospital Registry (Haeundae Paik SE Registry), which included all patients presented with SE during the period from January 2016 to December 2023. All patients had clearly documented SE at the time of admission and had a thorough medical and neurological investigations including brain MRI and EEG. All patients were older than 18 year-old, Patients who had SE caused by hypoxic-ischemic encephalopathy, were excluded from the study. Our investigations included, 1) the demographic data, 2) etiology of SE, which were divided into chronic epilepsy, remote symptomatic, acute symptomatic, or cryptogenic, 3) seizure-related changes in peri-ictal MRI (PMA): present or absenct, 4) peri-ictal EEG changes (PEA); present or absent, 5) response to the trial of 2^nd-line ASM; controlled or refractory. The response to the 2^nd-line ASM was defined as refractory if seizures continued after the trial of the 1^st –line ASM (iv-Lorazepam 8mg in two divided doses) and one of the 2^nd-line ASMs (levetiracetam, valproate, phenytoin, or lacosamide). According to 2021 ACNS terminology, we categorized peri-ictal EEG patterns into ESz/electroclinical seizures (ECSz), (IIC), and LPDs. PMA was defined as an abnormal increased signal intensity being localized to the cortex, thalamus, and/or hippocampus. PMA should not be the primary lesion responsible for the SE. Multivariate logistic regression model was conducted to investigate the relationship between electro-clinical variables with the semiology of SE.


Results: We found 114 patients with SE who met the inclusion criteria.. The electro-clinical variables suggesting NCSE more than CSE were; older age (p< 0.0001), female (p=0.0094), cryptogenic etiology of epilepsy (p=0.026), PEA (p=0.0001) and refractory SE (p=0.0026). Multivariate logistic model showed that PEA and age were independent significant variables differentiating NCSE from CSE; PEA, OR 3.97 (95% CI 1.6-9.8), p=0.0029; age, OR 1.08 (95% CI 1.04-1.12), p< 0.0001.xcv


Conclusions: SE could be a spectral condition. Older age and frequently observed PEA were more frequently related to NCSE than CSE, suggesting a different neuro-biological mechanism in the clinical expression of SE.


Funding: none