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P12-T Diagnostic criteria for NCSE in severe brain injury
Abstracts / Clinical Neurophysiology 130 (2019) e21–e116
In our study, 166 patients with cardiac arrest in coma were stratified according to 4 independent EEG patterns: benign, RSE, generalized periodic discharges [GPDs], malignant non-epileptiform. NSE level >68 ng/mL, bilateral absence of median nerve SEP and moderate to severe anoxic brain injury on neuroimaging, were considered indicators of poor prognosis. Of 166 patients that were included, a benign EEG pattern was recorded in 76 patients (45.8%); RSE occurred in 36 patients, a periodic pattern (GPDs) was seen in 13 patients (7.8%); and a malignant non epileptiform EEG pattern was recorded in 41 patients (24.7%). The four EEG patterns were highly associated with different prognostic indicators. Patients with benign EEG pattern and RSE showed lower NSE levels and were less likely to show bilateral absence N20 responses and severe anoxic brain injury on neuroimaging. On the other side, patients with GPDs and malignant pattern were associated more frequently with bilateral absence of N20 responses, higher NSE levels and severe anoxic brain injury on neuroimaging. These data show that the a benign EEG pattern and RSE without periodisms, may be a predictor of a good outcome and a more aggressive treatment may be indicated in this patients, given the possibility of a better prognosis. doi:10.1016/j.clinph.2019.04.373
P11-T The Effect of Carbamazepine on interictal epileptic discharges in patients with focal epilepsy—Shaymaa Alshrefaty (Basra Children Specialty Hospital, Basra, Iraq)
Background: According to the international league against epilepsy (ILAE) recommendations, carbamazepine (CBZ) is at present considered the first choice medicine in treatment of partial epilepsy with or without secondary generalization, CBZ affect cortical neurons by a variety of actions.The administration of CBZ and its derivatives should be scheduled with due regard to the form of epilepsy, specificity of individual EEG, EEG dynamics and clinical manifestation during the treatment. Materials & methods: this study was conducted at Basra general hospital from March to November 2014, (110) patients included in the study. Their age ranges 15–45 years. All patients did EEG exam at the beginning of the study by using digital EEG machine & the records with findings suggestive of IEDs were then independently reviewed. Patients started their treatment inform of carbamazepine (20 mg/kg/day), and a second EEG exam was done after six months. Patients who showed no compliance to treatment or showed resistance to treatment were excluded. Results: Out of (110) patients included in the study only (77) patients continue. The results revealed that (68) patients had highly significant reduction in mean IEDs at second EEG exam after six months of treatment with carbamazepine. And among them, fortytwo patients had no more clinical seizure attacks during the study time and twenty-six patients continue having seizure attacks three months after treatment. Conclusion: CBZ is still effective AED in the treatment of partial epilepsy and EEG is a good tool in the follow up of patient’s response to carbamazepine. doi:10.1016/j.clinph.2019.04.374
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P12-T Diagnostic criteria for NCSE in severe brain injury— Ekaterina Povaliukhina a,*, Tatyana Aleksandrova b, Alexei Ulitin a, Michael Aleksandrov a (a Almazov National Medical Research Center, Polenov Neurosurgical Institute (Branch, Clinic), Saintb Petersburg, Russian Federation, Saint-Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, SaintPetersburg, Russian Federation) ⇑
Corresponding author.
Background: Non-Convulsive Status Epilepticus (NCSE) is one of the variants of a prolonged unconscious state, associated with continuous epileptiform activity on EEG, but without major motor signs. The NCSE complicates the course of severe brain injury and worsens the prognosis for the patient. The existing ‘‘Salzburg criteria” are considering clinical and electrophysiological indicators apart from the duration of unconsciousness. Material and methods: A total of 31 patients suffering from NCSE with severe traumatic brain injury aged 20–65 years were examined. EEG registration was carried out on the ‘‘Mitsar-EEG-202” complex (LTD ‘‘Mitsar”, Russian Federation). EEG was performed dynamically at different times from the moment of injury. Results: In those patients who were examined upon 1–4 days from the moment of brain injury, the index of epileptiform activity ranged from 30 to 60%. For those to whom EEG was performed after 5–10 days, epileptiform activity was registered with an index from 10% to 30%. On EEG performed on days 11–15, epileptiform activity was present with an index of at least 10%. Conclusions: The criteria for diagnosing of non-convulsive status epilepticus depend on the duration of the patient’s unconscious state since the restoration of brain stem functioning, and also depend on the time elapsed since the moment of brain injury. doi:10.1016/j.clinph.2019.04.375
P13-T Epilepsy and sleep disorders: Coexistence in three patients—Maria Rita Pelejão a,*, Michel Mendes b, b c c a Pedro Guimarães , João Lopes , João Ramalheira ( Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal, b Department of Neurology, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal, c Department of Neurophysiology, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal) ⇑
Corresponding author.
Background: The relation of epilepsy and sleep disorders is wellknown and complex and the coexistence of these two groups of pathologies is frequent. Sleep can favour the occurrence of epileptic seizures and it can also be the sole triggering factor for epileptic seizures in some types of epilepsies. On the other hand, its known that the occurrence of sleep disorders is more frequent in epileptic patients than in general population. These can be explained by a common pathophysiologic mechanism and can also be exacerbated by some antiepileptic drugs. The clinical diagnosis can be difficult, often underestimated the presence of sleep disorders in epileptic patients. Long-term Monitoring and Polysomnography are essentials exams to perform an adequate diagnosis and treatment in these patients.
In our study, 166 patients with cardiac arrest in coma were stratified according to 4 independent EEG patterns: benign, RSE, generalized periodic discharges [GPDs], malignant non-epileptiform. NSE level >68 ng/mL, bilateral absence of median nerve SEP and moderate to severe anoxic brain injury on neuroimaging, were considered indicators of poor prognosis. Of 166 patients that were included, a benign EEG pattern was recorded in 76 patients (45.8%); RSE occurred in 36 patients, a periodic pattern (GPDs) was seen in 13 patients (7.8%); and a malignant non epileptiform EEG pattern was recorded in 41 patients (24.7%). The four EEG patterns were highly associated with different prognostic indicators. Patients with benign EEG pattern and RSE showed lower NSE levels and were less likely to show bilateral absence N20 responses and severe anoxic brain injury on neuroimaging. On the other side, patients with GPDs and malignant pattern were associated more frequently with bilateral absence of N20 responses, higher NSE levels and severe anoxic brain injury on neuroimaging. These data show that the a benign EEG pattern and RSE without periodisms, may be a predictor of a good outcome and a more aggressive treatment may be indicated in this patients, given the possibility of a better prognosis. doi:10.1016/j.clinph.2019.04.373
P11-T The Effect of Carbamazepine on interictal epileptic discharges in patients with focal epilepsy—Shaymaa Alshrefaty (Basra Children Specialty Hospital, Basra, Iraq)
Background: According to the international league against epilepsy (ILAE) recommendations, carbamazepine (CBZ) is at present considered the first choice medicine in treatment of partial epilepsy with or without secondary generalization, CBZ affect cortical neurons by a variety of actions.The administration of CBZ and its derivatives should be scheduled with due regard to the form of epilepsy, specificity of individual EEG, EEG dynamics and clinical manifestation during the treatment. Materials & methods: this study was conducted at Basra general hospital from March to November 2014, (110) patients included in the study. Their age ranges 15–45 years. All patients did EEG exam at the beginning of the study by using digital EEG machine & the records with findings suggestive of IEDs were then independently reviewed. Patients started their treatment inform of carbamazepine (20 mg/kg/day), and a second EEG exam was done after six months. Patients who showed no compliance to treatment or showed resistance to treatment were excluded. Results: Out of (110) patients included in the study only (77) patients continue. The results revealed that (68) patients had highly significant reduction in mean IEDs at second EEG exam after six months of treatment with carbamazepine. And among them, fortytwo patients had no more clinical seizure attacks during the study time and twenty-six patients continue having seizure attacks three months after treatment. Conclusion: CBZ is still effective AED in the treatment of partial epilepsy and EEG is a good tool in the follow up of patient’s response to carbamazepine. doi:10.1016/j.clinph.2019.04.374
e41
P12-T Diagnostic criteria for NCSE in severe brain injury— Ekaterina Povaliukhina a,*, Tatyana Aleksandrova b, Alexei Ulitin a, Michael Aleksandrov a (a Almazov National Medical Research Center, Polenov Neurosurgical Institute (Branch, Clinic), Saintb Petersburg, Russian Federation, Saint-Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, SaintPetersburg, Russian Federation) ⇑
Corresponding author.
Background: Non-Convulsive Status Epilepticus (NCSE) is one of the variants of a prolonged unconscious state, associated with continuous epileptiform activity on EEG, but without major motor signs. The NCSE complicates the course of severe brain injury and worsens the prognosis for the patient. The existing ‘‘Salzburg criteria” are considering clinical and electrophysiological indicators apart from the duration of unconsciousness. Material and methods: A total of 31 patients suffering from NCSE with severe traumatic brain injury aged 20–65 years were examined. EEG registration was carried out on the ‘‘Mitsar-EEG-202” complex (LTD ‘‘Mitsar”, Russian Federation). EEG was performed dynamically at different times from the moment of injury. Results: In those patients who were examined upon 1–4 days from the moment of brain injury, the index of epileptiform activity ranged from 30 to 60%. For those to whom EEG was performed after 5–10 days, epileptiform activity was registered with an index from 10% to 30%. On EEG performed on days 11–15, epileptiform activity was present with an index of at least 10%. Conclusions: The criteria for diagnosing of non-convulsive status epilepticus depend on the duration of the patient’s unconscious state since the restoration of brain stem functioning, and also depend on the time elapsed since the moment of brain injury. doi:10.1016/j.clinph.2019.04.375
P13-T Epilepsy and sleep disorders: Coexistence in three patients—Maria Rita Pelejão a,*, Michel Mendes b, b c c a Pedro Guimarães , João Lopes , João Ramalheira ( Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal, b Department of Neurology, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal, c Department of Neurophysiology, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal) ⇑
Corresponding author.
Background: The relation of epilepsy and sleep disorders is wellknown and complex and the coexistence of these two groups of pathologies is frequent. Sleep can favour the occurrence of epileptic seizures and it can also be the sole triggering factor for epileptic seizures in some types of epilepsies. On the other hand, its known that the occurrence of sleep disorders is more frequent in epileptic patients than in general population. These can be explained by a common pathophysiologic mechanism and can also be exacerbated by some antiepileptic drugs. The clinical diagnosis can be difficult, often underestimated the presence of sleep disorders in epileptic patients. Long-term Monitoring and Polysomnography are essentials exams to perform an adequate diagnosis and treatment in these patients.