Status Epilepticus In Patients Research Articles

Super-Refractory Status Epilepticus in Children: A Retrospective Cohort Study.

To characterize the pediatric super-refractory status epilepticus population by describing treatment variability in super-refractory status epilepticus patients and comparing relevant clinical characteristics, including outcomes, between super-refractory status epilepticus, and nonsuper-refractory status epilepticus patients. Retrospective cohort study with prospectively collected data between June 2011 and January 2019. Seventeen academic hospitals in the United States. We included patients 1 month to 21 years old presenting with convulsive refractory status epilepticus. We defined super-refractory status epilepticus as continuous or intermittent seizures lasting greater than or equal to 24 hours following initiation of continuous infusion and divided the cohort into super-refractory status epilepticus and nonsuper-refractory status epilepticus groups. None. We identified 281 patients (157 males) with a median age of 4.1 years (1.3-9.5 yr), including 31 super-refractory status epilepticus patients. Compared with nonsuper-refractory status epilepticus group, super-refractory status epilepticus patients had delayed initiation of first nonbenzodiazepine-antiseizure medication (149 min [55-491.5 min] vs 62 min [33.3-120.8 min]; p = 0.030) and of continuous infusion (495 min [177.5-1,255 min] vs 150 min [90-318.5 min]; p = 0.003); prolonged seizure duration (120 hr [58-368 hr] vs 3 hr [1.4-5.9 hr]; p < 0.001) and length of ICU stay (17 d [9.5-40 d] vs [1.8-8.8 d]; p < 0.001); more medical complications (18/31 [58.1%] vs 55/250 [22.2%] patients; p < 0.001); lower return to baseline function (7/31 [22.6%] vs 182/250 [73.4%] patients; p < 0.001); and higher mortality (4/31 [12.9%] vs 5/250 [2%]; p = 0.010). Within the super-refractory status epilepticus group, status epilepticus resolution was attained with a single continuous infusion in 15 of 31 patients (48.4%), two in 10 of 31 (32.3%), and three or more in six of 31 (19.4%). Most super-refractory status epilepticus patients (30/31, 96.8%) received midazolam as first choice. About 17 of 31 patients (54.8%) received additional treatments. Super-refractory status epilepticus patients had delayed initiation of nonbenzodiazepine antiseizure medication treatment, higher number of medical complications and mortality, and lower return to neurologic baseline than nonsuper-refractory status epilepticus patients, although these associations were not adjusted for potential confounders. Treatment approaches following the first continuous infusion were heterogeneous, reflecting limited information to guide clinical decision-making in super-refractory status epilepticus.

Temperature Management in Neurological and Neurosurgical Intensive Care Unit.

Temperature Management in Neurological and Neurosurgical Intensive Care Unit.

Continuous EEG monitoring in the follow-up of convulsive status epilepticus patients: A proposal and preliminary validation of an EEG-based seizure build-up score (EaSiBUSSEs)

Continuous electroencephalography (EEG) is a major tool for monitoring patients admitted to the intensive care unit after refractory convulsive status epilepticus, following control of convulsive movements. We review the values of different EEG patterns observed in critically ill patients for prognosis and seizure risk, together with proposed criteria for non-convulsive status epilepticus diagnosis (Salzburg Criteria), the EEG scores for prognosis (Epidemiology-based Mortality score in Status Epilepticus, EMSE) and for seizure risk (2HELPS2B). These criteria and scores, based partially on continuous EEG, are not tailored to repetitively monitor the progressive build-up leading to seizure or status epilepticus recurrence. Therefore, we propose a new EEG-based seizure build-up score in status epilepticus (EaSiBUSSEs), based on the morphology and the prevalence of the EEG patterns observed in the follow-up of convulsive status epilepticus patients. It displays subscores from the least (no interictal activity) to the most associated with seizures (focal or generalized status epilepticus). We then evaluated the performance of the EaSiBUSSEs in a cohort of eleven patients who were admitted to intensive care unit for convulsive status epilepticus and who underwent continuous EEG recording. The receiver operating curve revealed good accuracy in identifying patients who would have seizures in the next 24 h, with excellent intra- and inter-rater reliability. We believe that this score is simple to perform, and suitable for repeated monitoring of EEG following refractory convulsive status epilepticus, with quantitative description of major EEG changes leading to seizures.

Carbogen inhalation during non-convulsive status epilepticus: A quantitative exploratory analysis of EEG recordings.

To quantify the effect of inhaled 5% carbon-dioxide/95% oxygen on EEG recordings from patients in non-convulsive status epilepticus (NCSE). Five children of mixed aetiology in NCSE were given high flow of inhaled carbogen (5% carbon dioxide/95% oxygen) using a face mask for maximum 120s. EEG was recorded concurrently in all patients. The effects of inhaled carbogen on patient EEG recordings were investigated using band-power, functional connectivity and graph theory measures. Carbogen effect was quantified by measuring effect size (Cohen's d) between "before", "during" and "after" carbogen delivery states. Carbogen's apparent effect on EEG band-power and network metrics across all patients for "before-during" and "before-after" inhalation comparisons was inconsistent across the five patients. The changes in different measures suggest a potentially non-homogeneous effect of carbogen on the patients' EEG. Different aetiology and duration of the inhalation may underlie these non-homogeneous effects. Tuning the carbogen parameters (such as ratio between CO2 and O2, duration of inhalation) on a personalised basis may improve seizure suppression in future.

Fragile X Syndrome and Periventricular Heterotopias: A Rare Association

AbstractFragile X syndrome (FXS) is the most common hereditary cause of intellectual disability in males, with an estimated prevalence of 1:4000. Epilepsy occurs in 10 to 20% of males with FXS and usually has a favorable prognosis and positive response to antiepileptic medication. Numerous anomalies in the central nervous system have been reported in FXS. Among these, periventricular heterotopia (PH) has been reported in two previous cases. Epilepsy is also a common comorbidity in PH, but in contrast to epilepsy in FXS, the severity may vary markedly. We present a boy with FXS, PH, and epilepsy—a combination not previously reported in the literature. The presented case suggests a necessity to consider PH in cases of refractory epilepsy or status epilepticus in patients with FXS, emphasizes the importance of ruling out FXS in children with intellectual disability even if there are only discreet or no clinical signs of the disorder, and underscores that FXS should be considered in patients with PH if no other cause can be found.

Status epilepticus and other EEG findings in patients with COVID-19: A case series

PurposeNeurological manifestations of COVID-19 infection include impaired consciousness, strokes, and seizures. Limited reports describing EEG abnormalities in patients with COVID-19 have been published. These articles reported nonspecific encephalopathic patterns, epileptiform discharges, and rarely seizures. Our primary aim was to assess EEG abnormalities in patients with COVID-19 and evaluate for epileptiform activity or seizures. MethodsWe identified five critically ill adult patients with COVID-19 who underwent EEG monitoring. All patients had Ceribell™ rapid response EEG initially and two continued with conventional long-term video EEG. ResultsAll 5 patients had encephalopathy and 3 also had seizure-like movements, thus prompting EEG monitoring. EEGs all showed nonspecific markers of encephalopathy including diffuse slowing and generalized rhythmic delta activity. Two also had epileptiform discharges reaching 2−3 Hz at times, with one patient in nonconvulsive status epilepticus and the other developing clinical status epilepticus with myoclonic movements. EEG and clinical symptoms improved with anti-seizure medications. ConclusionStatus epilepticus was present in 2 out of our cohort of 5 critically ill patients who underwent EEG monitoring. These findings highlight the importance of EEG monitoring in high-risk patients with COVID-19 and encephalopathy. EEG recordings in such patients can identify pathological patterns that will benefit from treatment with anti-seizure medications.

Essential oil-related status epilepticus: A small case series study.

ObjectiveEssential oils are plant‐derived oils and are widely used as an over‐the‐counter remedy for common ailments. Many essential oils are found to have proconvulsant effects. Here we report a small case series of 3 adults with eseential oil‐related status epilepticus.MethodsThis was an observational study conducted in a tertiary care hospital in south India from January 2018 to December 2019. We collected the demographic, clinical, and imaging features of all cases of status epilepticus resulting from exposure to essential oils. Cases of status epilepticus secondary to all other causes were excluded.ResultsThere were 3 young adults with essential oil‐related status epilepticus. Two had de novo generalized tonic–clonic status epilepticus, and 1 with posttraumatic occipital lobe epilepsy had focal‐impaired awareness status epilepticus. The first 2 cases presented with histories of ingestion of eucalyptus oil. The third case had focal‐impaired awareness status epilepticus after topical application of various balms containing eucalyptus and camphor.ConclusionsProconvulsant essential oils of eucalyptus and camphor can cause both generalized and focal status epilepticus. Physicians dealing with patients of status epilepticus should enquire about the exposure to proconvulsant essential oils.

Is rat hippocampus section immunostaining an indicator for immunotherapy in cryptogenic adult new-onset refractory status epilepticus (NORSE)?

PurposeTo evaluate the meaning of immunostaining of rat hippocampus with respect to clinical manifestations, Status epilepticus(SE)severity, treatment, and prognosis of New-Onset Refractory Status Epilepticus(NORSE) patients. MethodsConsecutive patients with cryptogenic NORSE admitted to the neuro-intensive care unit (NICU) between January 2015 and October 2018 were screened, and those who had serum and cerebrospinal fluid (CSF) immunostaining were included. Subsequently, the patients were classified into positive and negative immunostain groups. Immunotherapy was initiated in patients who progressed to super-RSE (SRSE). The demographic, and clinical, and immunostaining data were collected. The prognosis was evaluated by modified Rankin scale (mRS) at discharge (short-term prognosis) and 6 months (long-term prognosis), with mRS score ≤2 defined as the favorable outcome. The clinical manifestations, treatment response, and prognosis were compared between the patients with positive and negative immunostains. Results4/18 patients had positive immunostaining on both CSF and serum, 8 (had positive immunostaining on serum only, while 6 had negative immunostaining on serum and CSF. Twelve (66.7 %) patients progressed to SRSE, with no difference between the positive and negative immunostaining groups (P = 1.000). 7/18 patients had a favorable outcome at discharge and 11/18 after 6 months. No significant difference on the prognosis was detected between patients with positive and negative serum/CSF immunostaining and between the patients with or without immunotherapy at discharge or 6-month follow-up (P = 0.657/P = 0.502, P = 0.445/P = 0.829, P = 0.622, P = 0.567, respectively). ConclusionsThe immunostaining on serum and/or CSF from NORSE patients did not indicate the progression to SRSE and clinical outcomes.

Clinical features associated with convulsive status epilepticus in patients with epilepsy

Aim: Status epilepticus (SE) is an important and distinct problem with its high morbidity and mortality. The need for early identification of SE to predict the course and prognosis of epilepsy have led us to investigate the clinical features associated with SE in patients with epilepsy in this study.Material and Methods: The information of the patients with epilepsy recorded comprised demographic features, type and etiology of seizures, age of onset of epilepsy, frequency of seizures, mono- or polytherapy treatment, history of convulsive SE, triggering factors for SE and brain magnetic resonance imaging findings. The data also included patients’ family history of epilepsy and history of febrile seizures, mental retardation.Results: A total of 610 patients with epilepsy (291 men, 319 women) were included in the study. It was found that 49 (8%) of the patients had at least one convulsive SE. Univariate logistic regression analysis showed that earlier onset of epilepsy, symptomatic/cryptogenic etiology, mental retardation, frequency of seizures ≥1/month, treatment with polytherapy, and abnormalities in neuroimaging are associated with SE (p=0.001, p0.001, p0.001, p0.001, p0.001 and p0.001, respectively). In multivariate logistic regression analysis; mental retardation (SE 0.380; 95% CI 0.186-0.825; p=0.014) and polytherapy (SE 0.392; 95% CI 0.158-0.735; p=0.006) were found to be independent factors related with SE. It was determined that 69% of patients had a triggering factor for SE and infection (65%) was the most common among these.Conclusion: The results of this study showed that there is a clear relationship between the occurrence of SE and mental retardation and treatment with polytherapy in patients with epilepsy. Symptomatic/cryptogenic etiology, early onset of epilepsy, high frequency of seizures and presence of abnormalities in neuroimaging are also associated with SE. Identification of these risk factors of SE will be helpful to initiate the appropriate treatment within a short time after diagnosis.

Cost analysis on status epilepticus patients treated in intensive care units

Costs need to be analyzed for an effective provision of healthcare services. In our country, there are insufficient number of studies on cost analysis of the treatment of Status Epilepticus (SE). In this study, we aimed to investigate the treatment costs of patients admitted to intensive care units due to SE and contribute to the relevant data in our country. We conducted a retrospective review of patients who were admitted to the intensive care unit with a definitive diagnosis of SE between August 2018 and August 2019. We evaluated the demographic data, duration of hospitalization in the intensive care unit, the type of SE, the treatments given before and during hospitalization, inpatient medications and total costs and mortality rates in patients with SE. The mean age of 16 patients with SE was 41.1 ± 26.0 years, with a female/male ratio of 7/9. The patients were divided into three groups: 8 patients with primary generalized convulsive SE, 6 patients with focal onset generalized convulsive SE and 2 patients with non-convulsive SE. The average number of days of hospitalization in the intensive care unit was 7.44. Two of the patients died during the follow-up period. The average cost of medicines was 1344.25 TL (224.60 USD) and the total treatment cost was 4197.02 TL (701.25 USD). Analysis of costs in the field of healthcare provides sustainable and predictable health expenditures. A linear relationship has been shown between the number of days of hospitalization in the intensive care unit and the costs of medicines. An advanced age and acute symptomatic seizures are the leading causes of increase in the number of days of hospitalization. Multicenter studies with a higher number of participants are needed for a more accurate understanding of this data in our country.

Drug use review of Intravenous Levetiracetam in Status Epilepticus patients at Srinagarind Hospital, Khon Kaen, Thailand

Drug use review of Intravenous Levetiracetam in Status Epilepticus patients at Srinagarind Hospital, Khon Kaen, Thailand

Clinical characteristics, EEG findings and implications of status epilepticus in patients with brain metastases

PurposeTo evaluate the clinical implications of status epilepticus in patients with metastases to the brain as well as associated demographic, clinical, EEG and radiographic features. MethodsRetrospective chart review of 19 patients with metastases to the brain who subsequently developed status epilepticus. ResultsOf the patients who developed status epilepticus only 36.8% had a prior history of seizures since diagnosis of brain metastases. Status epilepticus most commonly occurred in the setting of a new structural injury to the brain such as new metastases, increase in size of metastases or hemorrhage. 57.9% of patients had either refractory or super-refractory status epilepticus. Focal non-convulsive status epilepticus was the most common subtype occurring in 42.1% of patients. 31.6% of patients died within 30 days of the onset of status epilepticus. ConclusionStatus epilepticus eventually resolved with treatment in all patients with brain metastases; however, it is associated with poor outcomes as nearly one-third was deceased within 30-days of onset. Nevertheless, no patients died during status epilepticus. Thus, status epilepticus may be indicative of an overall poor clinical status among patients with brain metastases.

Calorie Intake During Status Epilepticus and Outcome: A 5-Year Cohort Study.

Recommendations regarding nutrition during status epilepticus are lacking, and it is unclear whether restriction of calorie intake would result in beneficial effects or potential harm. We thus aimed to investigate associations between daily calorie intake and outcome in adult status epilepticus patients deriving from a 5-year cohort with a systematic and prospective collection of nutritional data. Retrospective observational study. Medical ICUs at a tertiary academic medical care center. Consecutive patients with status epilepticus treated at the ICUs from 2012 to 2016 were included. None. All patients with status epilepticus were monitored regarding nutrition support provided according to the guidelines. Relative risks of no return to baseline were estimated by Poisson regression with robust error variance and adjusted for potential confounders. Of 203 patients, 86 (42%) had return to baseline. Metabolic characteristics of patients with and without return to baseline did not differ. Patients without return to baseline received more calories and proteins per status epilepticus day, and increasing nutritional support was associated with ventilator-associated pneumonia (relative risk, 1.19; 95% CI, 1.09-1.28). Multivariable regression analysis revealed significant increases in relative risks for no return to baseline with every percent of days with nutrition (relative risk, 1.35; 95% CI, 1.05-1.74), with every 100 kcal (relative risk, 1.01; 95% CI, 1.002-1.01), and gram of protein intake (relative risk, 1.01; 95% CI, 1.001-1.01) per status epilepticus day, independent of potential confounders (including fatal etiology, duration and severity of status epilepticus, Charlson comorbidity index, and treatment with anesthetics). Our results indicate that increased calorie intake during status epilepticus is independently associated with unfavorable outcome. These findings require further validation and investigations into potential mediators, such as induction of ketogenesis, immunomodulating effects, and/or reduction of ICU-associated complications, such as infections.

Uric acid is a useful marker to differentiate between responsive and refractory status epilepticus

ObjectivesEarly recognition of refractory status epilepticus (RSE) is essential to select an appropriate treatment strategy and is closely associated with the outcome. Only few studies of RSE biomarkers exist; hence, we investigated the serum levels of uric acid (UA), albumin, and C-reactive protein (CRP) as potential serologic biomarkers for RSE. Patients and MethodsConsecutive status epilepticus (SE) patients who had serial conventional blood tests in a referral hospital over a period of 10 years were retrospectively analyzed. Patients with anoxic encephalopathy, renal failure, acute stroke, and myocardial infarction were excluded. RSE was defined as seizure continuing after the first- and second-line treatments. We also assessed SE severity in all included patients using the Status Epilepticus Severity Score (STESS). General demographics and blood test findings were compared between responsive SE and RSE patients. ResultsA total of 141 patients (99 responsive and 42 refractory) were recruited from our SE registry. Compared to responsive patients, patients with RSE showed a higher STESS, lower initial albumin levels, lower initial UA levels, lower follow-up UA levels, and greater reduction of UA levels. The RSE group more frequently had acute symptomatic etiology, showed longer hospitalization, and had poorer functional outcomes compared to the responsive-SE group. All evaluated UA level parameters exhibited significant areas under the curve in receiver operating characteristic analyses, predictive of RSE. Initial UA levels, as well as changes therein, were significantly associated with RSE in multivariate logistic regression analysis. ConclusionUA levels at initial and follow-up evaluations, and changes therein differentiated responsive SE and RSE, demonstrating the feasibility of UA serum levels as a biomarker for RSE.

Tumor-associated status epilepticus in patients with glioma: Clinical characteristics and outcomes

Between 3 and 12% of all adult status epilepticus (SE) are caused by a brain tumor. Gliomas, and in particular, high-grade gliomas (HGGs), are at high risk of SE development. In this study, we aimed to describe the clinical characteristic and outcomes of tumor-associated SE (TASE) in a population of adult patients with glioma prospectively collected between 2013 and 2019. In the aforementioned period, we observed 26 TASE (median age: 68 years). Overall, 22 patients (85%) presented a HGG (one anaplastic astrocytoma and 21 a glioblastoma) while 4 had a LGG (two diffuse astrocytoma and two ganglioglioma). All the lesions were supratentorial, and the temporal lobe was the most frequently involved (20 patients). Fourteen patients (54%) had the SE episode as the first manifestation of the tumor; in the remaining 12 (all patients with a HGG), the development of SE heralded tumor progression or reappearance. When TASE outcomes were compared with the ones observed in the general population of SE (SEGP), the response to treatment was not different between the two populations (refractory SE (RSE)/super-refractory SE (SRSE) 12% versus 13%, p = 0.75). In the short-term, group with TASE had a significantly lower global disability (modified Rankin scale (mRS) < 3 at discharge: 60% versus 32%, p < 0.001; at 30 days follow-up: 62% versus 30%, p < 0.001) and mortality (30 days mortality: 4% versus 27%, p = 0.008). Six months and 1 year mortality did not show any difference between the two groups (6 months: 46% and 45%, respectively, p = 0.9; 1 year: 68% and 52%, respectively, p = 0.22).The appearance of TASE often heralds tumor grow and progression. Even in this context, it appears to be as treatment-responsive as SEGP and the short-term disability and mortality related to SE episode are lower than those observed in the SEGP.Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures.

The Clinical Spectrum of New-Onset Status Epilepticus.

There is a paucity of data on patients with new-onset status epilepticus in patients without a prior history of epilepsy; we aimed to describe clinical characteristics and assess variables predictive of outcomes. Retrospective cohort. Quaternary academic medical center. Adult patients with new-onset status epilepticus. Retrospective review of adults with new-onset status epilepticus admitted to Mayo Clinic, Rochester MN between January 1, 1990, and December 31, 2015, was performed. Patient demographics, status epilepticus etiology, Status Epilepticus Severity Score, and status epilepticus classification per the Status Epilepticus Severity Score were recorded. Six-month mortality and functional outcomes defined as modified Rankin scale (≥3 at last follow-up was considered poor) were primary outcomes. Refractory status epilepticus was a secondary outcome. None. One-hundred seventy-seven patients were included. Status epilepticus was convulsive in 124 (70.1%) and nonconvulsive in 53 (29.9%); 96 cases (54.2%) were refractory status epilepticus. Mean age at onset was 63 ± 18 years; 52.5% were greater than or equal to 65 years. Etiologies were acute in 50.8%, progressive in 18.1%, remote in 19.2%, and unknown in 11.9% patients. Six-month mortality was 32.2%, and 70.1% had poor modified Rankin scale at mean follow-up 3.1 ± 3.5 years. Age greater than or equal to 65 was a significant predictor of poor functional outcome and 6-month mortality. Loss of consciousness, status epilepticus classification, or age greater than or equal to 65 did not predict progression to refractory status epilepticus. Progression to refractory status epilepticus did not impact functional outcome or mortality at last follow-up. Poor outcomes in new-onset status epilepticus were associated with older age as well as predominantly progressive or remote symptomatic disease. Further prospective investigations assessing the course and outcomes of these patients would be useful in management and prognostication.

Schizophrenia following new-onset refractory status epilepticus secondary to antiphospholipid syndrome

New-onset refractory status epilepticus (NORSE) is a drug-resistant status epilepticus that often has a catastrophic outcome. Our patient was diagnosed with NORSE and had an EEG reading that showed status epilepticus persisting for 8 months in general anesthesia. After autoimmune workup showed positive antiphospholipid antibodies, his seizure was controlled, and he was discharged with good condition apart from moderate cognitive impairment. However, he later developed schizophrenia. Although psychiatric disorders have been associated with antiphospholipid syndrome, to the best of our knowledge, it has not been reported to be associated with status epilepticus. We recommend vigilance of psychological complications of refractory status epilepticus’ patients for early psychiatric referral, diagnosis, and treatment.

The effect of early midazolam infusion on the duration of pediatric status epilepticus patients

PurposeStatus epilepticus is one of the most common neurological emergencies in pediatric emergency departments. Although there are different approaches to treatment in the literature, early control of seizure activity is the most important factor determining prognosis. The purpose of this study was to evaluate the effect of early midazolam infusion on seizure duration. MethodThis retrospective study included 150 episodes of 135 patients aged one month to 18 years old with status epilepticus. All patients were treated according to the local hospital protocol for SE, which included early midazolam infusion. Demographic data, medical history, applied treatments during SE, and seizure durations were recorded. ResultsThe median age of the patients (58.7% male) was 2.7 years (1.0–6.0 years). The most common identified etiologies were remote symptomatic etiologies, and generalized tonic-clonic seizure was the most common seizure type. The pediatricians had selected intravenous midazolam for 130 patients (86.7%) as the first-line therapy in emergency services. In 55 patients given continuous midazolam infusion, the cumulative bolus of midazolam was 0.5 mg/kg (0.4–0.7 mg/kg), and the median peak rate of midazolam infusion was 0.2 mg/kg/h (0.2–0.4 mg/kg/h). The median duration between the start of midazolam infusion and the complete cessation of SE was 15.0 min (9.0–25.0 min). The early-midazolam infusion group had shorter seizure duration after initiation of midazolam infusion (p = 0.020). ConclusionThe current study shows that aggressive management of SE with early initiation of midazolam infusion was associated with a shorter seizure duration in SE patients.

Status epilepticus in patients with genetic (idiopathic) generalized epilepsy.

Aim of the studyGenetic (idiopathic) generalized epilepsies (GGEs) account for nearly one-third of all epilepsies. The frequency of status epilepticus (SE) in patients with GGEs has been poorly studied. Therefore, this study aimed to evaluate the frequency of different forms of SE in a cohort of patients with GGEs.Materials and methodsAmong 153 patients with GGEs treated at the university epilepsy clinic in the period between 1998 and 2018, those with SE were retrospectively identified.ResultsAbsence SE was diagnosed in 8 patients (13 episodes), while myoclonic SE was found in 2 patients (2 episodes). No cases of tonic–clonic SE were detected in the study cohort. Most SE episodes were found to be provoked by ill-advised antiepileptic drugs or changes in drug regimen. In all the subjects, SE was stopped by intravenous administration of diazepam and/or valproate. Long-term outcome of epilepsy was good, with most patients (70%) being seizure-free.ConclusionStatus epilepticus is not a rare phenomenon in patients with genetic generalized epilepsies, with absence SE being the most common type. Most cases of SE are provoked by ill-advised AEDs or changes in drug regimen. Status epilepticus in GGEs can be easily treated with benozdiazepines and/or valproate. Status epilepticus in GGEs can be easily treated with benozdiazepines and/or valproate.

P02-T Clinical outcome and EEG patterns in superrefractory-nonconvulsive status epilepticus- single centre experience

Background Nonconvulsive status epilepticus (NCSE) is a life threatening condition with very high mortality rate. The diagnosis is mainly based on electroencephalograpy (EEG). The aim was to study the EEG findings and epidemiology of superrefractory NCSE (SR-NCSE) in our center. Material and methods A retrospective database was compiled from patient files between 2013 and 2018. From 150 status epilepticus patients 13 were found to have SR-NCSE. EEG was evaluated ac-cording to the Salzburg Consensus Criteria. The following parameters were collected: status epilepticus severity score (STESS) and epidemiology-based mortality score in status epilepticus (EMSE), time until the diagnosis and clinical outcome. Results From the SE patients 8.6% had SR- NCSE, 77% of them female. The average age was 71.4 ± 21 years ( 90 30%.) The average time until the first EEG was 15.49 h, at the time of the diagnosis already in superrefractory stage. The mortality rate was very high (77%). The survivors had good outcome, modified Rankin scale 0–1. STESS and EMSE scores gave a good prediction of out-come. The 4 patients with burst-suppression pattern on EEG all died. The others had continuous epi-leptiform discharges (EDs, spikes and sharp waves). All who survived were alert or somnolent, and had an acute treatable aetiology. Only one patient had epileptic seizures previously and recovered. Conclusion Most NCSE cases stay hidden, or are diagnosed already in a refractory stage. Using STESS and EMSE scores helps to predict the outcome. Surveillance and education may improve the outcome and diagnosis of NCSE.