Nonkonvulsif Status Epileptikus
Özet
Status epileptikusun (SE) mekanizmaları, etiyolojileri, tedavi seçenekleri, izlem ve klinik sonuçları hakkındaki ilerlemeler, tanım ve tedavide önemli değişikliklere yol açmıştır. Tanı kriterlerindeki heterojenite ve klinik olarak bulgu vermemesi nedeni ile tanı konulmasındaki zorluklara rağmen NKSE sıklığının 2-8/100.000 olduğu tahmin edilmektedir. Uluslararası Epilepsi ile Mücadele Birliği (ILAE)’ne göre SE, nöbetin sonlandırılmasından sorumlu mekanizmaların başarısızlığından ya da anormal derecede uzamış nöbetlere yol açan mekanizmaların başlatılmasından kaynaklanan bir durum olarak tanımlanmaktadır. Anormal derecede uzamış bir nöbeti tanımlamakta kullanılan zaman eşiği, nöbetin türüne bağlıdır. Konvülsif status epileptikus (KSE) için bu süre beş dakikadır. Nonkonvulsif Status Epileptikus (NKSE) ise belirgin interiktal iyileşme olmaksızın on dakikadan uzun süren konvülsiyon olmaksızın devam eden nöbetler olarak tanımlanır. Bu bozukluk, belirgin motor bulguların yokluğunda çeşitli derecelerde bilinç değişikliği ile sonuçlanabilir. Bunun dışında belirgin motor aktivitenin olmadığı miyoklonik nöbet, anormal davranış, afazi, amnezi, halüsinasyonlar, nistagmus, tonik göz deviasyonu gibi semptomlar bildirilmiştir. KSE tek başına klinik özellikler kullanılarak teşhis edilebilirken, NKSE için EEG incelemesi esastır.
Advancements in our understanding of the mechanisms, etiologies, treatment options, monitoring, and clinical outcomes of Status Epilepticus (SE) have led to significant changes in its definition and management. Despite the difficulties in diagnosis due to the heterogeneity in diagnostic criteria and lack of clinical/motor findings in NCSE, the frequency is estimated to be 2-8/100,000. According to the International League Against Epilepsy (ILAE), SE is defined as a condition resulting from the failure of mechanisms responsible for terminating seizures or from the initiation of mechanisms that lead to abnormally prolonged seizures. The time threshold used to define an abnormally prolonged seizure depends on the type of seizure. For Convulsive Status Epilepticus (CSE), this duration is five minutes. Nonconvulsive Status Epilepticus (NCSE) is defined as seizures lasting for more than ten minutes without significant interictal recovery and without convulsions. This disorder can result in varying degrees of altered consciousness in the absence of prominent motor signs. Additionally, symptoms such as myoclonic seizures, abnormal behaviors, aphasia, amnesia, hallucinations, nystagmus, and tonic eye deviation have been reported. While CSE can be diagnosed based on clinical features alone, EEG examination is essential for NCSE.
Referanslar
Trinka E, Cock H, Hesdorffer D, et al. A definition and classification of status epilepticus--Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia. 2015;56:1515.
Hirsch LJ, Fong MWK, Leitinger M, et al. American Clinical Neurophysiology Society’s Standardized Critical Care EEG Terminology: 2021 Version. J Clin Neurophysiol. 2021;38(1):1-29.
Kinney MO, Craig JJ, Kaplan PW. Non-convulsive status epilepticus: mimics and chameleons. Pract Neurol. 2018;18(4):291-305.
Sutter R, Rüegg S, Kaplan PW. Epidemiology, diagnosis, and management of nonconvulsive status epilepticus: opening Pandora’s box. Neurology: Clinical Practice. 2012;2(4):275-286.
Vespa PM, Miller C, McArthur D, et al.Nonconvulsive electrographic seizures after traumatic brain injury result in a delayed, prolonged increase in intracranial pressure and metabolic crisis. CritCare Med. 2007;35:2830–2836.
Walker M, Cross H, Smith S, et al. Nonconvulsive status epilepticus: Epilepsy Research Foundation workshop reports. Epileptic Disord. 2005;7:253–96.
Foreman B, Hirsch LJ. Epilepsy emergencies: diagnosis and management. Neurol Clin. 2012;30:11.
Kennedy JD, Gerard EE. Continuous EEG monitoring in the intensive care unit. Curr Neurol Neurosci Rep. 2012;12:419.
Claassen J, Mayer SA, Kowalski RG, et al. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology. 2004;62:1743.
Abend NS, Gutierrez-Colina AM, Topjian AA, et al. Nonconvulsive seizures are common in critically ill children. Neurology. 2011;76:1071.
Brophy GM, Bell R, Claassen J, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17:3.
Dubé CM, Brewster AL, Richichi C, Zha Q, Baram TZ. Fever, febrile seizures and epilepsy. Trends in Neurosciences. 2007;30(10):490-6.
Payne ET, Zhao XY, Frndova H, et al. Seizure burden is independently associated with short term outcome in critically ill children. Brain. 2014; 137:1429.
Leitinger M, Trinka E, Gardella E, et al. Diagnostic accuracy of the Salzburg EEG criteria for non-convulsive status epilepticus: a retrospective study. Lancet Neurol. 2016;15:1054.
Tay SK, Hirsch LJ, Leary L, et al. Nonconvulsive status epilepticus in children: clinical and EEG characteristics. Epilepsia. 2006; 47:1504.
Cavusoglu D, Olgac Dundar N, Kamit F, et al. Evaluation of Nonconvulsive Status Epilepticus and Nonconvulsive Seizures in a Pediatric Intensive Care Unit. Clin Pediatr (Phila). 2023 Sep 23;62(8):879–84.
Beniczky S, Hirsch LJ, Kaplan PW, et al. Unified EEG terminology and criteria for nonconvulsive status epilepticus. Epilepsia. 2013;54 Suppl 6:28.
Jirsch J, Hirsch LJ. Nonconvulsive seizures: developing a rational approach to the diagnosis and management in the critically ill population. Clin Neurophysiol. 2007; 118:1660.
Leitinger M, Beniczky S, Rohracher A, et al. Salzburg Consensus Criteria for Non-Convulsive Status Epilepticus--approach to clinical application. Epilepsy Behav. 2015;49:158.
Foreman B, Hirsch LJ. Epilepsy emergencies: diagnosis and management. Neurol Clin. 2012;30:11.
Saengpattrachai M, Sharma R, Hunjan A, et al. Nonconvulsive seizures in the pediatric intensive care unit: etiology, EEG, and brain imaging findings. Epilepsia. 2006;47:1510.
Trinka E, Leitinger M. Which EEG patterns in coma are nonconvulsive status epilepticus?. Epilepsy & Behavior. 2015 Aug;49:203–22.
Jordan KG, Hirsch LJ. In nonconvulsive status epilepticus (NCSE), treat to burst-suppression: pro and con. Epilepsia. 2006;47 Suppl 1:41.
Neyal A, Neyal AM. Non-konvülsif status epileptikus. Turkiye Klinikleri J Neurol-Special Topics. 2016;9(3):95- 101.
Treiman DM, Meyers PD, Walton NY, et al. A comparison off our treatments for generalized convulsive status epilepticus: Veterans Affairs Status Epilepticus Cooperative Study Group. NEnglJMed. 1998;339:792–8.
Alldredge BK, Gelb AM, Isaacs SM, et al. A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med. 2001; 345:631.
Kapur J, Elm J, Chamberlain JM, et al. Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus. N Engl J Med. 2019; 381:2103.
Shirasaka Y. Lack of neuronal damage in atypical absence status epilepticus. Epilepsia. 2002; 43:1498.
Shneker BF, Fountain NB. Assessment of acute morbidity and mortality in nonconvulsive status epilepticus. Neurology. 2003; 61:1066.
Referanslar
Trinka E, Cock H, Hesdorffer D, et al. A definition and classification of status epilepticus--Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia. 2015;56:1515.
Hirsch LJ, Fong MWK, Leitinger M, et al. American Clinical Neurophysiology Society’s Standardized Critical Care EEG Terminology: 2021 Version. J Clin Neurophysiol. 2021;38(1):1-29.
Kinney MO, Craig JJ, Kaplan PW. Non-convulsive status epilepticus: mimics and chameleons. Pract Neurol. 2018;18(4):291-305.
Sutter R, Rüegg S, Kaplan PW. Epidemiology, diagnosis, and management of nonconvulsive status epilepticus: opening Pandora’s box. Neurology: Clinical Practice. 2012;2(4):275-286.
Vespa PM, Miller C, McArthur D, et al.Nonconvulsive electrographic seizures after traumatic brain injury result in a delayed, prolonged increase in intracranial pressure and metabolic crisis. CritCare Med. 2007;35:2830–2836.
Walker M, Cross H, Smith S, et al. Nonconvulsive status epilepticus: Epilepsy Research Foundation workshop reports. Epileptic Disord. 2005;7:253–96.
Foreman B, Hirsch LJ. Epilepsy emergencies: diagnosis and management. Neurol Clin. 2012;30:11.
Kennedy JD, Gerard EE. Continuous EEG monitoring in the intensive care unit. Curr Neurol Neurosci Rep. 2012;12:419.
Claassen J, Mayer SA, Kowalski RG, et al. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology. 2004;62:1743.
Abend NS, Gutierrez-Colina AM, Topjian AA, et al. Nonconvulsive seizures are common in critically ill children. Neurology. 2011;76:1071.
Brophy GM, Bell R, Claassen J, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17:3.
Dubé CM, Brewster AL, Richichi C, Zha Q, Baram TZ. Fever, febrile seizures and epilepsy. Trends in Neurosciences. 2007;30(10):490-6.
Payne ET, Zhao XY, Frndova H, et al. Seizure burden is independently associated with short term outcome in critically ill children. Brain. 2014; 137:1429.
Leitinger M, Trinka E, Gardella E, et al. Diagnostic accuracy of the Salzburg EEG criteria for non-convulsive status epilepticus: a retrospective study. Lancet Neurol. 2016;15:1054.
Tay SK, Hirsch LJ, Leary L, et al. Nonconvulsive status epilepticus in children: clinical and EEG characteristics. Epilepsia. 2006; 47:1504.
Cavusoglu D, Olgac Dundar N, Kamit F, et al. Evaluation of Nonconvulsive Status Epilepticus and Nonconvulsive Seizures in a Pediatric Intensive Care Unit. Clin Pediatr (Phila). 2023 Sep 23;62(8):879–84.
Beniczky S, Hirsch LJ, Kaplan PW, et al. Unified EEG terminology and criteria for nonconvulsive status epilepticus. Epilepsia. 2013;54 Suppl 6:28.
Jirsch J, Hirsch LJ. Nonconvulsive seizures: developing a rational approach to the diagnosis and management in the critically ill population. Clin Neurophysiol. 2007; 118:1660.
Leitinger M, Beniczky S, Rohracher A, et al. Salzburg Consensus Criteria for Non-Convulsive Status Epilepticus--approach to clinical application. Epilepsy Behav. 2015;49:158.
Foreman B, Hirsch LJ. Epilepsy emergencies: diagnosis and management. Neurol Clin. 2012;30:11.
Saengpattrachai M, Sharma R, Hunjan A, et al. Nonconvulsive seizures in the pediatric intensive care unit: etiology, EEG, and brain imaging findings. Epilepsia. 2006;47:1510.
Trinka E, Leitinger M. Which EEG patterns in coma are nonconvulsive status epilepticus?. Epilepsy & Behavior. 2015 Aug;49:203–22.
Jordan KG, Hirsch LJ. In nonconvulsive status epilepticus (NCSE), treat to burst-suppression: pro and con. Epilepsia. 2006;47 Suppl 1:41.
Neyal A, Neyal AM. Non-konvülsif status epileptikus. Turkiye Klinikleri J Neurol-Special Topics. 2016;9(3):95- 101.
Treiman DM, Meyers PD, Walton NY, et al. A comparison off our treatments for generalized convulsive status epilepticus: Veterans Affairs Status Epilepticus Cooperative Study Group. NEnglJMed. 1998;339:792–8.
Alldredge BK, Gelb AM, Isaacs SM, et al. A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med. 2001; 345:631.
Kapur J, Elm J, Chamberlain JM, et al. Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus. N Engl J Med. 2019; 381:2103.
Shirasaka Y. Lack of neuronal damage in atypical absence status epilepticus. Epilepsia. 2002; 43:1498.
Shneker BF, Fountain NB. Assessment of acute morbidity and mortality in nonconvulsive status epilepticus. Neurology. 2003; 61:1066.
