ABSTRACT
The Neurocritical Care Society′s Guidelines for the Evaluation and Management of Status Epilepti-cus defines status epilepticus as the epilepsy lasts for 5 minutes or longer,with continuous clinical and/or electrographic seizure activity or recurrent seizure activity without recovery (returning to baseline) between seizures.Nonconvulsive status epilepticus (NCSE) can be classified into with or without coma/stupor types.The diagnosis of NCSE needs continuous video electroencephalogram monitoring and the indications include:(1) altered mental status appear after seizures,acute brain injury or other unknown causes;(2)efficacy evaluation of seizure therapy is performed to confirm whether nonconvulsive seizures or NCSE is controlled monitoring for 24 to 48 hours;(3)identification of cerebral ischemia.Modified Salzburg consensus criteria for NCSE suggests that the diagnosis of NCSE needs the combination of clinical features and electroencephalograms.Suspected clinical features and signs of NCSE should last at least 10 minutes,and altered EEG of suspected NCSE should last at least 10 seconds.Benzodiazepines is the first choice of treatment in NCSE and antiepileptic drugs are selected if necessary.If the NCSE lasts longer than 60 minutes,anesthetics or other therapies may be administered.
ABSTRACT
BACKGROUND: Triphasic waves are one of the electroencephalographic patterns that can be usually seen in metabolic encephalopathy. The aim of this study is to compare the clinical and electrophysiologic profiles between patients with and without triphasic waves in metabolic encephalopathy, and reassess the significance of triphasic waves in metabolic encephalopathy. METHODS: We recruited 127 patients with metabolic encephalopathy, who were admitted to our hospital. We divided these admitted patients into two groups; those with and without triphasic waves. We analyzed the difference of duration of hospitalization, mortality rate during admission, Glasgow Coma Scale, severity of electroencephalographic alteration, and presence of acute symptomatic seizures between these two groups. RESULTS: Of the 127 patients with metabolic encephalopathy, we excluded 67 patients who did not have EEG, and 60 patients finally met the inclusion criteria for this study. Patients with triphasic waves had more severe electroencephalographic alterations, lower Glasgow Coma Scale, and more acute symptomatic seizures than those without triphasic waves. After adjusting the clinical variables, Glasgow Coma Scale and acute symptomatic seizures were only significantly different between patients with and without triphasic waves. CONCLUSIONS: We demonstrated that patients with triphasic waves in metabolic encephalopathy had more significant impairment of the brain function.