Prior History Of Seizures Research Articles

720. Respiratory and Nonrespiratory Complications Among Patients Hospitalized with Influenza, FluSurv-NET, 2016–2017

BackgroundInfluenza is most commonly associated with respiratory complications; however, nonrespiratory complications occur frequently among patients hospitalized with influenza. We used data from the Influenza Hospitalization Surveillance Network (FluSurv-NET) to describe complications recorded on discharge summaries of patients hospitalized with influenza.MethodsWe included children (0–17 years) and adults (≥18 years), who resided within a FluSurv-NET catchment area and were hospitalized with laboratory-confirmed influenza during 2016–2017. We abstracted data on underlying conditions and discharge diagnoses from medical charts. We calculated the frequency of respiratory and nonrespiratory complications in all age groups and used univariate and multivariable logistic regression to examine factors associated with select complications among adults.ResultsAmong 17,489 patients, the most common respiratory complications were pneumonia (26%) and acute respiratory failure (23%) and the most common nonrespiratory complications were sepsis (16%) and acute renal failure (ARF) (12%). Complications varied by age group (figure). Pneumonia was the most common respiratory complication in all age groups except 0–4 years; among children aged 0–4 years bronchiolitis was most common (104/712; 15%). Among 97 children aged 0–4 years with bronchiolitis who underwent testing for respiratory syncytial virus (RSV), 37% had RSV. The most common nonrespiratory complication was seizures in children aged 0–17 years (17% had a history of prior seizures) and sepsis in adults. Among adults (n = 16,057), factors most strongly associated with ARF included chronic renal disease (adjusted odds ratio (AOR) 2.5; 95% confidence interval (95% CI) 2.2–2.8), male sex (AOR 1.5 95% CI 1.4–1.7) and age ≥65 years (AOR 1.4 95% CI 1.2–1.7); the factor most strongly associated with sepsis was chronic neuromuscular disease (AOR 1.5 95% CI 1.3–1.8).ConclusionInfluenza hospitalizations are associated with a broad spectrum of complications including pneumonia, respiratory failure, sepsis, ARF and seizures. During the influenza season, astute clinicians should keep influenza in the differential diagnosis for patients with a wide range of presentations. :Disclosures. H. K. Talbot, sanofi pasteur: Investigator, Research grant. Gilead: Investigator, Research grant. MedImmune: Investigator, Research grant. Vaxinnate: Safety Board, none. Seqirus: Safety Board, none. E. J. Anderson, NovaVax: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. AbbVie: Consultant, Consulting fee. MedImmune: Investigator, Research support. PaxVax: Investigator, Research support. Micron: Investigator, Research support.

Sociodemographic Profile, Semiology, and Etiology of Patients with Status Epilepticus: A Study from a Tertiary Care Hospital in North India.

Background and Objectives:Despite advance in treatment of status epilepticus (SE), a major neurological emergency, it is still associated with mortality and morbidity. The objective of our study was to estimate sociodemographic profile, semiology, and etiology in the children with SE admitted in pediatric intensive care.Materials and Methods:Children between 1 month and 18 years with continuous seizure activity of >5 min or two or more sequential seizures without full recovery of consciousness between seizures, admitted in the Pediatric Intensive Care Unit of the Department of Pediatrics, Government Medical College, Srinagar, were included in the study. A semi-structured tool was designed to record the sociodemographic details. Detailed history, clinical examination, and investigations (including neuroimaging as and when needed) were used to determine the type of seizure and etiology.Results:A total of 51 patients were included in our study. Most of the patients were <5 years with 47.10% in 1–5 years’ age group and 43.10% in >1-year age group. Males (60.80%) outnumbered females. Thirty-nine patients (76.47%) belonged to “known” or “symptomatic” group with 35 (68.60%) of them presenting with SE as their fresh seizure. Thirty-nine (76.47%) of our patients had generalized tonic–clonic seizure (GTCS) type of SE.Conclusion:Most of the children (90%) were below the age of 5 years with male predominance. Most of the patients had SE as their first seizure without prior history of seizures with GTCSs was the most frequent seizure type.

Is Shunt Evaluation Useful in Children With Intraventricular Shunts With Seizures?

BackgroundSeizures are a common presenting symptom to the emergency department (ED) in children with intraventricular shunts (IVS). The incidence of shunt malfunction and the yield of imaging studies in children with IVS presenting with seizures is unknown. ObjectivesWe assessed the utility and diagnostic yield of evaluation for shunt malfunction in patients with IVS with seizure and identified clinical predictors for shunt malfunction in these children. MethodsWe performed a retrospective review of children aged zero to 21 years of age with IVS who presented to the ED with seizure between 2011 and 2015. Demographic, clinical, laboratory and radiological data were collected. Shunt malfunction was diagnosed based on whether a shunt revision was performed during the hospitalization. ResultsWe evaluated 408 ED visits (median age: six years [IQR: 3, 11], males 61.5%) for IVS with seizures. Few visits were for first seizure (37; 9.1%) or for status epilepticus (46 visits; 11.3%). Computerized tomography head was performed in 318 patients (95.2%), of which 32 scans (10.6%) were suggestive of shunt malfunction. A shunt series was performed in 302 (90.4%) and was suggestive of shunt malfunction in eight (2.6%) patients. Shunt malfunction was diagnosed in 40 of 408 visits (9.8%). Only a history of multiple (≥3) shunt revisions was significantly associated with shunt malfunction. There was no association between number, type, or prior history of seizures and shunt malfunction. ConclusionOur study demonstrates a low yield of imaging studies for the evaluation of shunt malfunction in children with IVS with seizures, and shunt malfunction is an uncommon cause of seizures in these children.

Population-Based Assessment of the Long-Term Risk of Seizures in Survivors of Stroke.

We sought to determine the long-term risk of seizures after stroke according to age, sex, race, and stroke subtype. We performed a retrospective cohort study using administrative claims from 2 complementary patient data sets. First, we analyzed data from all emergency department visits and hospitalizations in California, Florida, and New York from 2005 to 2013. Second, we evaluated inpatient and outpatient claims from a nationally representative 5% random sample of Medicare beneficiaries. Our cohort consisted of all adults at the time of acute stroke hospitalization without a prior history of seizures. Our outcome was seizure occurring after hospital discharge for stroke. Poisson regression and demographic data were used to calculate age-, sex-, and race-standardized incidence rate ratios (IRR). Among 777 276 patients in the multistate cohort, the annual incidence of seizures was 1.68% (95% confidence interval [CI], 1.67%-1.70%) after stroke versus 0.15% (95% CI, 0.15%-0.15%) among the general population (IRR, 7.3; 95% CI, 7.3-7.4). By 8 years, the cumulative rate of any emergency department visit or hospitalization for seizure was 9.27% (95% CI, 9.16%-9.38%) after stroke versus 1.21% (95% CI, 1.21%-1.22%) in the general population. Stroke was more strongly associated with a subsequent seizure among patients <65 years of age (IRR, 12.0; 95% CI, 11.9-12.2) than in patients ≥65 years of age (IRR, 5.5; 95% CI, 5.4-5.5) and in the multistate analysis, the association between stroke and seizure was stronger among nonwhite patients (IRR, 11.0; 95% CI, 10.8-11.2) than among white patients (IRR, 7.3; 95% CI, 7.2-7.4). Risks were especially elevated after intracerebral hemorrhage (IRR, 13.3; 95% CI, 13.0-13.6) and subarachnoid hemorrhage (IRR, 13.2; 95% CI, 12.8-13.7). Our study of Medicare beneficiaries confirmed these findings. Almost 10% of patients with stroke will develop seizures within a decade. Hemorrhagic stroke, nonwhite race, and younger age seem to confer the greatest risk of developing seizures.

Auras and the risk of seizures with impaired consciousness following epilepsy surgery: implications for driving

ObjectiveTo calculate the chance of a seizure in the next year (COSY) for seizures with impaired awareness in those experiencing auras only, those with no seizures and those with continuing...

Temporal profile of care following mild traumatic brain injury: predictors of hospital admission, follow-up referral and six-month outcome

ABSTRACTObjective: To investigate the clinical management and medical follow-up of patients with mild traumatic brain injury (mTBI) presenting to emergency departments (EDs). Methods: Overall, 168 adult patients with mTBI from the prospective, multicentre Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) Pilot study with Glasgow Coma Scale (GCS) 13–15, no polytrauma and alive at six months were included. Predictors for hospital admission, three-month follow-up referral and six-month functional disability (Glasgow Outcome Scale-Extended (GOSE) ≤ 6) were analysed using multivariable regression. Results: Overall, 48% were admitted to hospital, 22% received three-month referral and 27% reported six-month functional disability. Intracranial pathology on ED head computed tomography (multivariable odds ratio (OR) = 81.08, 95% confidence interval (CI) [10.28–639.36]) and amnesia (>30-minutes: OR = 5.27 [1.75–15.87]; unknown duration: OR = 4.43 [1.26–15.62]) predicted hospital admission. Older age (per-year OR = 1.03 [1.01–1.05]) predicted three-month referral, while part-time/unemployment predicted lack of referral (OR = 0.17 [0.06–0.50]). GCS < 15 (OR = 2.46 [1.05–5.78]) and prior history of seizures (OR = 3.62 [1.21–10.89]) predicted six-month functional disability, while increased education (per-year OR = 0.86 [0.76–0.97]) was protective. Conclusions: Clinical factors modulate triage to admission, while demographic/socioeconomic elements modulate follow-up care acquisition; six-month functional disability associates with both clinical and demographic/socioeconomic variables. Improving triage to acute and outpatient care requires further investigation to optimize resource allocation and outcome after mTBI.ClinicalTrials.gov registration: NCT01565551

Time-dependent risk of seizures in critically ill patients on continuous electroencephalogram.

Find the optimal continuous electroencephalographic (CEEG) monitoring duration for seizure detection in critically ill patients. We analyzed prospective data from 665 consecutive CEEGs, including clinical factors and time-to-event emergence of electroencephalographic (EEG) findings over 72 hours. Clinical factors were selected using logistic regression. EEG risk factors were selected a priori. Clinical factors were used for baseline (pre-EEG) risk. EEG findings were used for the creation of a multistate survival model with 3 states (entry, EEG risk, and seizure). EEG risk state is defined by emergence of epileptiform patterns. The clinical variables of greatest predictive value were coma (31% had seizures; odds ratio [OR] = 1.8, p < 0.01) and history of seizures, either remotely or related to acute illness (34% had seizures; OR = 3.0, p < 0.001). If there were no epileptiform findings on EEG, the risk of seizures within 72 hours was between 9% (no clinical risk factors) and 36% (coma and history of seizures). If epileptiform findings developed, the seizure incidence was between 18% (no clinical risk factors) and 64% (coma and history of seizures). In the absence of epileptiform EEG abnormalities, the duration of monitoring needed for seizure risk of <5% was between 0.4 hours (for patients who are not comatose and had no prior seizure) and 16.4 hours (comatose and prior seizure). The initial risk of seizures on CEEG is dependent on history of prior seizures and presence of coma. The risk of developing seizures on CEEG decays to <5% by 24 hours if no epileptiform EEG abnormalities emerge, independent of initial clinical risk factors. Ann Neurol 2017;82:177-185.

Dimethyl sulfoxide (DMSO) cryopreserved stem cell infusion-related seizures: A single institution experience.

e19002 Background: An essential step in hematopoietic stem cell transplantation (HSCT) is the cryopreservation of stem cells in DMSO. Neurologic complications related to DMSO are well known and include strokes, seizures, encephalopathy and coma, but risk factors have not been identified. We focused on seizures as a DMSO-related neurologic adverse event. Methods: From 1/2006 to 4/2016, 982 cases of HSCT were reviewed. We identified neurologic adverse events within 24h of stem cell infusion (SCI). Results: 16 cases of neurologic adverse events occurred, including transient paresthesias (2), altered mental status (5), syncope (3), stroke (1), and 5 seizures. The mean age of the patients (pt) was 64.2 years (range 52-79), with 2 females and 3 males. All 5 pts developed seizures during SCI. 4 pts had conditioning: 2 Melphalan, 1 BEAM and 1 Bu/Cy. One pt received SCI without conditioning as a last resort to treat severe neutropenia and overwhelming sepsis. Of these 5 cases, one had a prior history of seizures in the setting of primary CNS lymphoma and 1 had a prior history of stroke, and 1 pt had an acute stroke during SCI. These 3 cases had abnormal EEG with a potential focus for seizure. Conclusions: Understanding the predisposing factors for developing seizures with SCI will improve patient safety and outcomes. History of structural brain lesions or seizure may be a risk factor for development of seizures. Applying prophylactic strategies, such as DMSO removal or prophylactic antiepileptic medications prior to SCI may decrease the risk of seizures. [Table: see text]

Seizure rates in enzalutamide (ENZ)-treated men with metastatic castration-resistant prostate cancer (mCRPC) at increased risk of seizure: UPWARD study.

147 Background: ENZ is an androgen receptor inhibitor that improved survival in studies of men with mCRPC. Seizure is a risk of ENZ treatment, and patients (pts) with seizure risk factors were excluded in prior studies. In the TRUVEN report (data on file), pts with mCRPC and potential seizure risk factors, but no ENZ exposure, had a seizure rate of 2.8/100 pt-years. The UPWARD study assessed the seizure risk in ENZ-treated pts with mCRPC who had potential seizure risk factors. Methods: This was a global, multicenter, single-arm, open-label safety study. Enrolled pts had ≥ 1 baseline potential seizure risk factor, including medications lowering seizure threshold, stroke, or prior seizure history. Evaluable pts had ≥ 3 months (ms) of treatment with ENZ or ≥ 1 confirmed seizure in a 4-m treatment period. Exclusion criteria included seizure within the past 12 ms and receipt of anti-epileptic medication. Pts received ENZ (160 mg/day). The primary end point was the proportion of evaluable pts with ≥ 1 confirmed seizure during the 4-m treatment period. Results: A total of423 pts received ENZ; 366 were evaluable. Baseline seizure risk factors were medications lowering seizure threshold (n = 242), brain injury (n = 112), and cerebrovascular accident/transient ischemic attack history (n = 94). Four (1.1%) evaluable pts had ≥ 1 confirmed seizure within 4 ms of ENZ initiation. Four (1.1%) pts had a first seizure after 4 ms. The rate of confirmed seizure was 2.6/100 pt-years. 357 pts (84.4%) experienced ≥ 1 treatment-emergent adverse event (TEAE); 141 (33.3%) had ≥ 1 serious TEAE and 29 (6.9%) had ≥ 1 drug-related serious AE. 38 (9.0%) deaths were reported during treatment/within 30 days of discontinuation; four deaths were considered possibly drug related (cerebral hemorrhage, mCRPC progression, sudden cardiac death, and general deterioration). Conclusions: The incidence of confirmed seizures in the UPWARD study is similar to pts with mCRPC and similar risk factors but no ENZ exposure in the TRUVEN report. ENZ was generally well tolerated, and TEAE data are consistent with its known safety profile. These results suggest that ENZ did not increase the risk of seizures in the UPWARD study. Clinical trial information: NCT01977651.

Hyponatremia-Induced Seizures Secondary to Magnesium Citrate Colon Cleansing Agent

Mild and clinically insignificant electrolyte disturbances are a well-recognised complication of all bowel preparation. Seizure as a complication is very rare. Magnesium citrate, a hyperosmolar substance, is often used for bowel preparation before colonoscopy and colon surgery. We report a 74-years-old female, with no prior history of seizures, who had her first seizure associated with hyponatremia following ingestion of magnesium citrate for bowel preparation. A careful correction of serum sodium must be undertaken. The patient improved her mental status to baseline after intravenous infusion of hypertonic saline. The other causes of hyponatremia and seizure were ruled out. This case highlights the association between magnesium citrate bowel preparations with significant hyponatremia and seizure. The physicians in the ED and general practice need to be aware of this serious complication of magnesium citrate bowel preparation to diagnose them early and initiate timely management.

Prophylactic antiepileptic drug administration following brain tumor resection: results of a recent AANS/CNS Section on Tumors survey.

OBJECTIVE Antiepileptic drugs (AEDs) are often administered prophylactically following brain tumor resection. With conflicting evidence and unestablished guidelines, however, the nature of this practice among tumor surgeons is unknown. METHODS On November 24, 2015, a REDCap (Research Electronic Database Capture) survey was sent to members of the AANS/CNS Section on Tumors to query practice patterns. RESULTS Responses were received from 144 individuals, including 18.8% of board-certified neurosurgeons surveyed (across 86 institutions, 16 countries, and 5 continents). The majority reported practicing in an academic setting (85%) as a tumor specialist (71%). Sixty-three percent reported always or almost always prescribing AED prophylaxis postoperatively in patients with a supratentorial brain tumor without a prior seizure history. Meanwhile, 9% prescribed occasionally and 28% rarely prescribed AED prophylaxis. The most common agent was levetiracetam (85%). The duration of seizure prophylaxis varied widely: 25% of surgeons administered prophylaxis for 7 days, 16% for 2 weeks, 21% for 2 to 6 weeks, and 13% for longer than 6 weeks. Most surgeons (61%) believed that tumor pathology influences epileptogenicity, with high-grade glioma (39%), low-grade glioma (31%), and metastases (24%) carrying the greatest seizure risk. While the majority used prophylaxis, 62% did not believe or were unsure if prophylactic AEDs reduced seizures postoperatively. The vast majority (82%) stated that a well-designed randomized trial would help guide their future clinical decision making. CONCLUSIONS Wide knowledge and practice gaps exist regarding the frequency, duration, and setting of AED prophylaxis for seizure-naive patients undergoing brain tumor resection. Acceptance of universal practice guidelines on this topic is unlikely until higher-level evidence supporting or refuting the value of modern seizure prophylaxis is demonstrated.

Intraoperative seizures during craniotomy under general anesthesia

PurposeAn acute symptomatic seizure is a clinical seizure occurring at the time of or in close temporal association with a brain insult. We report an acute symptomatic seizure occurring during a surgical procedure in a patient who did not have a prior history of epilepsy and who did not have a lesion associated with an increased risk of epilepsy. To characterize the incidence and clinical features of intraoperative seizures during craniotomy under general anesthesia, we reviewed cases where continuous EEG was acquired during craniotomy. MethodRecords of 400 consecutive cases with propofol as general anesthesia during craniotomy were reviewed. Demographic data, indication for surgery, clinical history, history of prior seizures, duration of surgery and duration of burst suppression were recorded. Cases where seizures were observed were analyzed in detail. ResultsTwo out of 400 patients experienced intraoperative seizures, including one patient who appeared to have an acute symptomatic seizure related to the surgical procedure itself and a second patient who experienced two seizures likely related to an underlying diagnosis of epilepsy. ConclusionsThis is the first report of an acute symptomatic seizure secondary to a neurosurgical procedure. Overall, 0.5% of patients monitored experienced seizures, indicating that intraoperative seizures are rare, and EEG monitoring during craniotomies is of low yield in detecting seizures.

Complex Partial Seizure as a Manifestation of Non-Ketotic Hyperglycemia: The Needle Recovered From Haystack?

We present a case of a 75-year-old gentleman with undiagnosed type 2 diabetes mellitus presenting with acute onset expressive dysphasia and right hemi-paresis with no prior history of seizure. He developed clusters of stereotypical complex partial seizures which were refractory to anti-epileptic agents. He was not known to have diabetes and his brain MRI was normal. His random blood sugar measurement on admission to hospital was 30 mmol/L with HbA1c measurement of 14.8%. His seizures terminated completely when his hyperglycemia was corrected with insulin and rehydration therapy.

HCP-07THE INFLUENCE OF PERIOPERATIVE SEIZURE PROPHYLAXIS ON SEIZURE RATE AND HOSPITAL QUALITY METRICS AFTER GLIOMA SURGERY

BACKGROUND: Seizures represent one of the most common and feared perioperative complications following brain tumor surgery. Despite conflicting evidence regarding efficacy, prophylactic antiepileptic drugs (AED) are frequently administered in an effort to reduce seizure incidence and improve patient and hospital reported outcomes. The authors address this question by examining an institutional glioma population. METHODS: Patients with glioma undergoing craniotomy for resection between 1998 and 2014 were enrolled into our institutional tumor registry. Perioperative seizures were considered those occurring within 14 days of the index surgery. Student t-test and multivariate logistic regression were used to analyze differences in means between continuous and categorical variables, respectively. RESULTS: Among 347 patients undergoing craniotomy for glioma resection, 299 (86.2%) were administered prophylactic AED post-operatively. Levetiracetam was the preferred agent, utilized in 73.7% of subjects. Sixteen (5.3%) patients receiving prophylactic AED suffered a perioperative seizure, compared to 1 (2.1%) not on prophylaxis (p = 0.62). Among the 17 patients that suffered a perioperative seizure, only 6 (35%) had a prior history of seizure. Mean hospital length of stay (LOS) was similar between both groups: 3.29 (AED) vs. 3.54 (no AED) days, p = 0.626. Similarly, there was no difference in ICU LOS among patients receiving (2.25 days) and not receiving (2.64 days) seizure prophylaxis, p = 0.38. The prophylaxis group had a similar rate of 90-day ED visits as the non-prophylaxis group: 12.0 vs. 17.0%, p = 0.341. However, patients administered seizure prophylaxis were less likely to be readmitted within 90 days of the index surgery (21.9 vs. 35%, p = 0.041). CONCLUSIONS: To the authors' knowledge this is the first study specifically evaluating the influence of perioperative seizure prophylaxis on emerging hospital quality metrics including length of stay and readmission. Interestingly, while associated with lower rates of readmission, perioperative AED administration fails to reduce the risk of post-operative seizures or hospital and ICU LOS.

Drug-induced status epilepticus.

Drug-induced status epilepticus (SE) is a relatively uncommon phenomenon, probably accounting for less than 5% of all SE cases, although limitations in case ascertainment and establishing causation substantially weaken epidemiological estimates. Some antiepileptic drugs, particularly those with sodium channel or GABA(γ-aminobutyric acid)-ergic properties, frequently exacerbate seizures and may lead to SE if used inadvertently in generalized epilepsies or less frequently in other epilepsies. Tiagabine seems to have a particular propensity for triggering nonconvulsive SE sometimes in patients with no prior history of seizures. In therapeutic practice, SE is most commonly seen in association with antibiotics (cephalosporins, quinolones, and some others) and immunotherapies/chemotherapies, the latter often in the context of a reversible encephalopathy syndrome. Status epilepticus following accidental or intentional overdoses, particularly of antidepressants or other psychotropic medications, has also featured prominently in the literature: whilst there are sometimes fatal consequences, this is more commonly because of cardiorespiratory or metabolic complications than as a result of seizure activity. A high index of suspicion is required in identifying those at risk and in recognizing potential clues from the presentation, but even with a careful analysis of patient and drug factors, establishing causation can be difficult. In addition to eliminating the potential trigger, management should be as for SE in any other circumstances, with the exception that phenobarbitone is recommended as a second-line treatment for suspected toxicity-related SE where the risk of cardiovascular complications is higher anyways and may be exacerbated by phenytoin. There are also specific recommendations/antidotes in some situations. The outcome of drug-induced status epilepticus is mostly good when promptly identified and treated, though less so in the context of overdoses. This article is part of a Special Issue entitled "Status Epilepticus".

Predictors of acute symptomatic seizures after intracranial hemorrhage in infants.

To determine the prevalence of acute symptomatic seizures in infants with supratentorial intracranial hemorrhage, to identify potential risk factors, and to determine the effect of acute seizures on long-term morbidity and mortality. Children less than 24 months with intracranial hemorrhage were identified from a neurocritical care database. All patients who received seizure prophylaxis beginning at admission were included in the study. Risk factors studied were gender, etiology, location of hemorrhage, seizure(s) on presentation, and the presence of parenchymal injury. Acute clinical and electrographic seizures were identified from hospital medical records. Subsequent development of late seizures was determined based on clinical information from patients' latest follow-up. Patients with idiopathic neonatal intracranial hemorrhage, premature infants, and those with prior history of seizures were excluded from analysis. Seventy-two infants met inclusion criteria. None. Forty percent of infants had acute symptomatic seizures. The prevalence was similar regardless of whether etiology of hemorrhage was traumatic or nontraumatic. Seizures on presentation and parenchymal injury were independent risk factors of acute seizures (p = 0.001 and p = 0.006, respectively). Younger children and women were also at higher risk (p < 0.05). Twenty percent had electrographic-only seizures, and those with parenchymal injury trended toward an increased risk (p < 0.1). Acute seizures were not predictive of mortality, but nearly twice as many patients with acute seizures developed late seizures when compared with those without. Electrographic seizures and parenchymal injury were also predictive of development of late seizures (p < 0.001 and p = 0.013, respectively). Despite seizure prophylaxis, infants with supratentorial intracranial hemorrhage are at high risk for acute symptomatic seizures. This is regardless of the etiology of hemorrhage. Younger patients, women, patients with parenchymal injury, and patients presenting with seizure are most likely to develop acute seizures. Although the benefits of seizure prophylaxis have not been studied in this specific population, these results suggest that it is an important component of acute care following intracranial hemorrhage.

P-50 * THE PREVALENCE OF SEIZURES DURING WITHDRAWAL FROM ALCOHOL, BENZODIAZEPINES AND OPIATES IN MEDICALLY MONITORED DETOXIFICATION CENTER

Generalized tonic-clonic seizures are the common severe complication of drug withdrawal. Efforts to prevent occurrence of seizures is an important factor in improvement of safety and quality of patient care. Medically monitored detoxification centers admit patients with known history of withdrawal seizures as well as history of seizure disorders for detoxification from alcohol benzodiazepines and opioids. Over last two years 12356 patients were admitted for inpatient detoxification, 260 patients had known history of seizures due to variety of etiologies. Patients underwent detoxification using chlordiazepoxide, phenobarbital and methadone. During last 2 years 38 patients developed seizures during detoxification. All occurrences were reviewed on the monthly basis as a part of quality of patient care monitoring. Majority of seizures are early onset events and occur within 48 hours from time of admission due to alcohol, and combined alcohol/ benzodiazepine withdrawal. Minority of seizures were related to benzodiazepine/opioid withdrawal, and use of medication lowering the seizure threshold like bupropion and antipsychotics, and were of late onset. In conclusion majority of tonic-clonic seizures in patients undergoing detoxification in medically monitored are an early onset seizures occurring in patients withdrawing from alcohol or alcohol/benzodiazepine combination. Detoxification using log acting benzodiazepines or phenobarbital is a safe therapy for patients with prior history of seizures. Avoidance of medication reducing seizure threshold may further reduce incidence of seizures.

Nonconvulsive status epilepticus in cancer patients with altered mental status.

e13028 Background: Non-convulsive status epilepticus (NCSE) is a potentially treatable etiology of unexplained altered mental status (AMS) in cancer patients. NCSE may be under-recognized clinically making electroencephalogram (EEG) essential for diagnosis. The purpose of this study was to determine the incidence of NCSE among patients with cancer undergoing inpatient neurology consultation for AMS, and to characterize their clinical features. Methods: We retrospectively reviewed the clinical records of 512 patients undergoing neurology consult for AMS between 1/1/2010-12/30/2011, and identified those with a diagnosis of NCSE. Basic demographics, primary cancer, clinical presentation, clinical course, and outcomes data were collected. Results: 21 patients were diagnosed with NCSE by EEG, an incidence of 4%. Of the 21, 3 had prior history of seizures and were maintained on antiepileptic drugs (AEDs). Ten had a solid primary cancer, 11 had a hematologic primary cancer, of which 6 were post-transplant. Eleve...

ABSTRACT 329

Background and aims: Status Epilepticus (SE) continues to be one of the most common pediatric acute care emergencies. Conventional SE protocols advocate Phenobarbitone as a second line antiepileptic drug (AED) if the child continues to seize even after Benzodiazepine (BZD) and Fosphenytoin (FPE) loading. Aims: We aimed to investigate the efficacy and safety of Levetiracetam as stage two AED in pediatric SE in place of phenobarbitone. Methods: Study design: Prospective observational study All consecutive children admitted to pediatric emergency during the study period (Jan 2012 to Nov 2013) received second stage AED Levetiracetam to control SE were included in the study to describe the safety and efficacy of Levetiracetam. Results: Of 111 children admitted with convulsive SE during the study period, 33 (36.7%) received Levetiracetam as stage two AED to achieve seizure control. Intravenous Levetiracetam at 30 mg/kg over 15 minutes followed by 10 mg/kg/dose as maintenance at 8 hourly interval was administered in all those enrolled. The mean age of presentation was 45.6 months [45.6(20.5–70.7)]. Among those received Levetiracetam, 22 children [67%; 22/33] had first episode seizure presenting as SE and 11 children [33%; 11/33] have had prior history of seizure. Levetiracetam had comparable efficacy (84%) and time to abort SE (16 min) to phenobarbitone as second stage AED without any side effects. Conclusions: This study concludes that Levetiracetam has comparable efficacy to be used as a second line AED in managing convulsive SE in infants and children with better side effect profile.

Clinical Reasoning: A 68-year-old man with a first presentation of status epilepticus

A 64-year-old man with transfusion-dependent myelodysplastic syndrome (MDS), hypertension, chronic obstructive pulmonary disease, hypothyroidism, blindness from treated syphilitic chorioretinitis, and no prior seizure history presented in generalized status epilepticus. His daily home medication regimen included prednisone 20 mg (chronic therapy for MDS), diltiazem 120 mg, digoxin 250 μg, tiotropium 80 μg, and levothyroxine 112 μg. On admission he was febrile to 39.9 °C and in atrial fibrillation with rapid ventricular rate. Initial hematologic profile showed 11,910 leukocytes/mm(3) (12% immature forms, 46% neutrophils, 32% lymphocytes), hematocrit of 30.8%, and platelet count of 215,000/mm(3), with an otherwise normal serum chemistry.