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Campos-Fernández D, Montes A, Thonon V, Sueiras M, Rodrigo-Gisbert M, Pasini F, Quintana M, López-Maza S, Fonseca E, Coscojuela P, Santafe M, Sánchez A, Arikan F, Gandara DF, Sala-Padró J, Falip M, López-Ojeda P, Gabarrós A, Toledo M, Santamarina E, Abraira L. Early focal electroencephalogram and neuroimaging findings predict epilepsy development after aneurysmal subarachnoid hemorrhage. Epilepsy Behav 2024; 156:109841. [PMID: 38768551 DOI: 10.1016/j.yebeh.2024.109841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/07/2024] [Accepted: 05/12/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Seizures are a common complication of subarachnoid hemorrhage (SAH) in both acute and late stages: 10-20 % acute symptomatic seizures, 12-25 % epilepsy rate at five years. Our aim was to identify early electroencephalogram (EEG) and computed tomography (CT) findings that could predict long-term epilepsy after SAH. MATERIAL AND METHODS This is a multicenter, retrospective, longitudinal study of adult patients with aneurysmal SAH admitted to two tertiary care hospitals between January 2011 to December 2022. Routine 30-minute EEG recording was performed in all subjects during admission period. Exclusion criteria were the presence of prior structural brain lesions and/or known epilepsy. We documented the presence of SAH-related cortical involvement in brain CT and focal electrographic abnormalities (epileptiform and non-epileptiform). Post-SAH epilepsy was defined as the occurrence of remote unprovoked seizures ≥ 7 days from the bleeding. RESULTS We included 278 patients with a median follow-up of 2.4 years. The mean age was 57 (+/-12) years, 188 (68 %) were female and 49 (17.6 %) developed epilepsy with a median latency of 174 days (IQR 49-479). Cortical brain lesions were present in 189 (68 %) and focal EEG abnormalities were detected in 158 patients (39 epileptiform discharges, 119 non-epileptiform abnormalities). The median delay to the first EEG recording was 6 days (IQR 2-12). Multiple Cox regression analysis showed higher risk of long-term epilepsy in those patients with CT cortical involvement (HR 2.6 [1.3-5.2], p 0.009), EEG focal non-epileptiform abnormalities (HR 3.7 [1.6-8.2], p 0.002) and epileptiform discharges (HR 6.7 [2.8-15.8], p < 0.001). Concomitant use of anesthetics and/or antiseizure medication during EEG recording had no influence over its predictive capacity. ROC-curve analysis of the model showed good predictive capability at 5 years (AUC 0.80, 95 %CI 0.74-0.87). CONCLUSIONS Focal electrographic abnormalities (both epileptiform and non-epileptiform abnormalities) and cortical involvement in neuroimaging predict the development of long-term epilepsy. In-patient EEG and CT findings could allow an early risk stratification and facilitate a personalized follow-up and management of SAH patients.
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Affiliation(s)
- D Campos-Fernández
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - A Montes
- Epilepsy Unit, Neurology department,Bellvitge University Hospital. Barcelona, Spain
| | - V Thonon
- Neurophysiology Department, Vall d'Hebron University Hospital. Barcelona, Spain
| | - M Sueiras
- Neurophysiology Department, Vall d'Hebron University Hospital. Barcelona, Spain; Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - M Rodrigo-Gisbert
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - F Pasini
- Epilepsy Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - M Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - S López-Maza
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - E Fonseca
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - P Coscojuela
- Neuroradiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - M Santafe
- Intensive Care Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - A Sánchez
- Intensive Care Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - F Arikan
- Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Neurosurgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - D F Gandara
- Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Neurosurgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - J Sala-Padró
- Epilepsy Unit, Neurology department,Bellvitge University Hospital. Barcelona, Spain
| | - M Falip
- Epilepsy Unit, Neurology department,Bellvitge University Hospital. Barcelona, Spain
| | - P López-Ojeda
- Neurosurgery Department, Bellvitge University Hospital, Barcelona, Spain
| | - A Gabarrós
- Neurosurgery Department, Bellvitge University Hospital, Barcelona, Spain
| | - M Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - E Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - L Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
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Llauradó A, Quintana M, Fonseca E, Abraira L, Toledo M, Requena M, Olivé M, Ballvé A, Campos D, Sueiras M, Santamarina E. Implications of starting antiepileptic treatment prior to electroencephalography in first epileptic seizures. Neurologia 2023; 38:647-652. [PMID: 37858895 DOI: 10.1016/j.nrleng.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/17/2021] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION This study aimed to determine whether the administration of antiepileptic drugs (AED) alters the likelihood of detecting epileptiform abnormalities in electroencephalographies (EEG) performed early after a first epileptic seizure. METHODS We performed a retrospective, observational study including patients with a first seizure attended at our centre's emergency department between July 2014 and November 2019. We collected clinical data, as well as technical data on the acquisition and interpretation of the EEG performed within the first 72 hours after the seizure, and the factors related with seizure recurrence. RESULTS We recruited 155 patients with a mean (SD) age of 48.6 (22.5) years; 61.3% were men. Regarding seizure type, 51% presented tonic-clonic seizures of unknown onset and 12% presented focal to bilateral tonic-clonic seizures. Thirty-nine patients (25.2%) received AED treatment before the EEG was performed: 33 received a non-benzodiazepine AED and 6 received a benzodiazepine. Epileptiform abnormalities were observed in 29.7% of patients. Previous administration of AEDs was not significantly associated with the probability of detecting interictal epileptiform abnormalities (P = .25) or with the risk of recurrence within 6 months (P = .63). CONCLUSIONS Administration of AEDs before an early EEG following a first seizure does not decrease the likelihood of detecting epileptiform abnormalities. These findings suggest that starting AED treatment immediately in patients with a high risk of early recurrence does not imply a reduction in the diagnostic accuracy of the test.
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Affiliation(s)
- A Llauradó
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Quintana
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - E Fonseca
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - L Abraira
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Toledo
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Requena
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Olivé
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A Ballvé
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - D Campos
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Sueiras
- Servicio, de Neurofisiología Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - E Santamarina
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
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Llauradó A, Quintana M, Fonseca E, Abraira L, Toledo M, Requena M, Olivé M, Ballvé A, Campos D, Sueiras M, Santamarina E. Implications of initiating antiseizure drugs prior to the performance of EEG in first epileptic seizures. Neurologia 2021; 38:S0213-4853(21)00053-0. [PMID: 33875301 DOI: 10.1016/j.nrl.2021.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/11/2021] [Accepted: 02/17/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This study aimed to determine whether the administration of antiepileptic drugs (AED) alters the likelihood of detecting epileptiform abnormalities in electroencephalographies (EEG) performed early after a first epileptic seizure. METHOD We performed a retrospective, observational study including patients with a first seizure attended at our centre's emergency department between July 2014 and November 2019. We collected clinical data, as well as technical data on the acquisition and interpretation of the EEG performed within the first 72hours after the seizure, and the factors related with seizure recurrence. RESULTS We recruited 155 patients with a mean (SD) age of 48.6 (22.5) years; 61.3% were men. Regarding seizure type, 51% presented tonic-clonic seizures of unknown onset and 12% presented focal to bilateral tonic-clonic seizures. Thirty-nine patients (25.2%) received AED treatment before the EEG was performed: 33 received a non-benzodiazepine AED and 6 received a benzodiazepine. Epileptiform abnormalities were observed in 29.7% of patients. Previous administration of AEDs was not significantly associated with the probability of detecting interictal epileptiform abnormalities (P=.25) or with the risk of recurrence within 6 months (P=.63). CONCLUSIONS Administration of AEDs before an early EEG following a first seizure does not decrease the likelihood of detecting epileptiform abnormalities. These findings suggest that starting AED treatment immediately in patients with a high risk of early recurrence does not imply a reduction in the diagnostic accuracy of the test.
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Affiliation(s)
- A Llauradó
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Quintana
- Unidad de Epilepsia; Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - E Fonseca
- Unidad de Epilepsia; Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - L Abraira
- Unidad de Epilepsia; Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Toledo
- Unidad de Epilepsia; Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Requena
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Olivé
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - A Ballvé
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - D Campos
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Sueiras
- Servicio, de Neurofisiología Clínica, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - E Santamarina
- Unidad de Epilepsia; Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España.
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Llauradó A, Santamarina E, Fonseca E, Olivé M, Requena M, Sueiras M, Guzmán L, Ballvé A, Campos D, Seijó I, Abraira L, Quintana M, Toledo M. How soon should urgent EEG be performed following a first epileptic seizure? Epilepsy Behav 2020; 111:107315. [PMID: 32694039 DOI: 10.1016/j.yebeh.2020.107315] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Patients with a first unprovoked epileptic seizure are often seen in emergency services. Electroencephalography (EEG) is indicated for diagnosing epilepsy, but the optimal time to perform this test has not been defined. This study aimed to determine the time interval following a seizure within which EEG has the greatest diagnostic yield. METHODS We conducted a retrospective study of all adult patients with a first unprovoked seizure who had undergone emergency EEG (July 2014-December 2019). Data collection included demographics, seizure type, time interval to EEG study, EEG pattern identified, and the prescription after emergency assessment. An optimal cut-off point for time to EEG was obtained, and an adjusted regression model was performed to establish associations with the presence of epileptiform abnormalities. RESULTS A total of 170 patients were included (mean age: 50.7 years, 40.6% women). Epileptiform discharges were identified in 34.1% of recordings, nonepileptiform abnormalities in 46.5%, and normal findings in 19.4%. A lower latency from seizure to EEG was associated with a higher probability of finding epileptiform discharges (median: 12.7 in the epileptiform EEGs vs. 20 h in the nonepileptiform EEGs, p < 0.001). The time interval associated with the highest probability of detecting an epileptiform EEG pattern was within the first 16 h after seizure onset: 52.1% of recordings performed before the 16-h cut-off showed these abnormal patterns compared with 20.2% performed after (p < 0.001). These findings were not related to the presence of an epileptogenic lesion in neuroimaging or to other clinical variables. The finding of epileptiform abnormalities was followed by a greater prescription of antiseizure drugs (96.4% vs. 66% in nonepileptiform patterns, p < 0.001). CONCLUSION The diagnostic yield of EEG following a first unprovoked epileptic seizure is highest when this test is performed within the first 16 h after onset of the event.
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Affiliation(s)
- A Llauradó
- Neurology Department, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - E Santamarina
- Epilepsy Unit, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain.
| | - E Fonseca
- Epilepsy Unit, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - M Olivé
- Neurology Department, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - M Requena
- Neurology Department, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - M Sueiras
- EEG Unit, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - L Guzmán
- EEG Unit, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - A Ballvé
- Neurology Department, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - D Campos
- Neurology Department, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - I Seijó
- Epilepsy Unit, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - L Abraira
- Epilepsy Unit, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - M Quintana
- Epilepsy Unit, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - M Toledo
- Epilepsy Unit, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
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González‐Cuevas M, Santamarina E, Toledo M, Quintana M, Sala J, Sueiras M, Guzman L, Salas‐Puig J. Response to Dr Voring
et al
. Eur J Neurol 2017; 24:e74. [DOI: 10.1111/ene.13384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 06/28/2017] [Indexed: 11/26/2022]
Affiliation(s)
- M. González‐Cuevas
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Universitat Autonoma de Barcelona Barcelona Spain
| | - E. Santamarina
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Universitat Autonoma de Barcelona Barcelona Spain
| | - M. Toledo
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Universitat Autonoma de Barcelona Barcelona Spain
| | - M. Quintana
- Neurology Department Vall d'Hebron University Hospital Universitat Autonoma de Barcelona Barcelona Spain
| | - J. Sala
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Universitat Autonoma de Barcelona Barcelona Spain
| | - M. Sueiras
- Neurophysiology Department Vall d'Hebron University Hospital Universitat Autonoma de Barcelona Barcelona Spain
| | - L. Guzman
- Neurophysiology Department Vall d'Hebron University Hospital Universitat Autonoma de Barcelona Barcelona Spain
| | - J. Salas‐Puig
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Universitat Autonoma de Barcelona Barcelona Spain
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Aller-Alvarez J, Menéndez-González M, Ribacoba-Montero R, Salvado M, Vega V, Suárez-Moro R, Sueiras M, Toledo M, Salas-Puig J, Álvarez-Sabin J. Myoclonic epilepsy in Down syndrome and Alzheimer disease. Neurología (English Edition) 2017. [DOI: 10.1016/j.nrleng.2014.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Aller-Alvarez J, Menéndez-González M, Ribacoba-Montero R, Salvado M, Vega V, Suárez-Moro R, Sueiras M, Toledo M, Salas-Puig J, Álvarez-Sabin J. Epilepsia mioclónica en el síndrome de Down y en la enfermedad de Alzheimer. Neurologia 2017; 32:69-73. [DOI: 10.1016/j.nrl.2014.12.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 12/09/2014] [Accepted: 12/11/2014] [Indexed: 10/24/2022] Open
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González‐Cuevas M, Santamarina E, Toledo M, Quintana M, Sala J, Sueiras M, Guzman L, Salas‐Puig J. A new clinical score for the prognosis of status epilepticus in adults. Eur J Neurol 2016; 23:1534-40. [DOI: 10.1111/ene.13073] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 06/08/2016] [Indexed: 11/30/2022]
Affiliation(s)
- M. González‐Cuevas
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Universitat Autonoma de Barcelona BarcelonaSpain
| | - E. Santamarina
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Universitat Autonoma de Barcelona BarcelonaSpain
| | - M. Toledo
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Universitat Autonoma de Barcelona BarcelonaSpain
| | - M. Quintana
- Neurology Department Vall d'Hebron University Hospital Universitat Autonoma de Barcelona BarcelonaSpain
| | - J. Sala
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Universitat Autonoma de Barcelona BarcelonaSpain
| | - M. Sueiras
- Neurophysiology Department Vall d'Hebron University Hospital Universitat Autonoma de Barcelona Barcelona Spain
| | - L. Guzman
- Neurophysiology Department Vall d'Hebron University Hospital Universitat Autonoma de Barcelona Barcelona Spain
| | - J. Salas‐Puig
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Universitat Autonoma de Barcelona BarcelonaSpain
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Santamarina E, Gonzalez M, Toledo M, Sueiras M, Guzman L, Rodríguez N, Quintana M, Mazuela G, Salas-Puig X. Prognosis of status epilepticus (SE): Relationship between SE duration and subsequent development of epilepsy. Epilepsy Behav 2015; 49:138-40. [PMID: 26117525 DOI: 10.1016/j.yebeh.2015.04.059] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 04/21/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED In animal models, SE duration is related to epileptogenesis. Data in humans are scarce, mainly in NCSE; therefore, we aimed to study the prognosis of SE de novo and which factors may influence subsequent development of epilepsy. METHODS We evaluated patients with SE without previous epilepsy at our hospital (February 2011-February 2014), including demographics, etiology, number of AEDs, duration of SE, mortality, and occurrence of seizures during follow-up. RESULTS Eighty-nine patients were evaluated. Median age was 69 (19-95) years old. Among them, 33.7% were convulsive. Regarding etiology, 59 were considered acute symptomatic (41 lesions, 18 toxic-metabolic), 17 remote or progressive symptomatic, and 13 cryptogenic. The median recovery time was 24h (30 min-360 h). In-hospital mortality was 29% (n = 26). After a median follow-up of 10 months, 58.7% of survivors (n = 37) showed seizures. Subsequently, we analyzed which factors might be related to the development of epilepsy, and we found that epilepsy development was more frequent with longer SE duration (37 vs. 23 h, p = 0.004); furthermore, patients with a toxic-metabolic etiology developed epilepsy less frequently (33% vs. 67%; p = 0.022). Epilepsy was also correlated (tendency) with focal SE (p = 0.073), a lesion in neuroimaging (p = 0.091), and the use of 2 or more AEDs (p = 0.098). Regarding SE duration, a cutoff of above 24h was clearly related to chronic seizures (p = 0.014); however, combining etiology and duration, the association of longer SE and epilepsy was significant in acute lesional SE (p = 0.034), but not in epilepsy with cryptogenic or remote/progressive etiology. After a logistic regression, only a duration longer than 24h (OR = 3.800 (1.277-11.312), p = 0.016) was found to be an independent predictor of the development of epilepsy. CONCLUSION In patients with SE, the longer duration is associated with an increased risk of subsequent epilepsy at follow-up, mainly in symptomatic SE due to an acute lesion. It is unclear if it might be the result of a more severe injury causing both prolonged seizures and subsequent epilepsy, and therefore whether more aggressive treatment in this group might avoid this possibility. Most of the patients with cryptogenic or remote/progressive SE developed epilepsy regardless of SE duration. This article is part of a Special Issue entitled "Status Epilepticus".
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Affiliation(s)
- E Santamarina
- Epilepsy Unit, Hospital Vall Hebron, Barcelona, Spain.
| | - M Gonzalez
- Epilepsy Unit, Hospital Vall Hebron, Barcelona, Spain
| | - M Toledo
- Epilepsy Unit, Hospital Vall Hebron, Barcelona, Spain
| | - M Sueiras
- Department of Neurophysiology, Hospital Vall Hebron, Barcelona, Spain
| | - L Guzman
- Department of Neurophysiology, Hospital Vall Hebron, Barcelona, Spain
| | - N Rodríguez
- Epilepsy Unit, Hospital Vall Hebron, Barcelona, Spain
| | - M Quintana
- Department of Neurology, Hospital Vall Hebron, Barcelona, Spain
| | - G Mazuela
- Epilepsy Unit, Hospital Vall Hebron, Barcelona, Spain
| | - X Salas-Puig
- Epilepsy Unit, Hospital Vall Hebron, Barcelona, Spain
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Thonon V, Sueiras M, Guzmán L, Nos C, Yaguee J, Gelpi E, Martínez R, Álvarez J. P195: The value of EEG in the neurophysiological diagnosis of the Creutzfeldt-Jakob disease. Our iconographic contribution on variable genotypes. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50330-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sueiras M, Sahuquillo J, García-López B, Sánchez-Guerrero Á, Poca MA, Santamarina E, Riveiro M, Fabricius M, Strong AJ. [Cortical spreading depolarization phenomena in patients with traumatic and ischemic brain injuries. Results of a pilot study]. Med Intensiva 2013; 38:413-21. [PMID: 24342071 DOI: 10.1016/j.medin.2013.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 08/14/2013] [Accepted: 09/29/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To determine the frequency and duration of cortical spreading depolarization (CSD) and CSD-like episodes in patients with traumatic brain injury (TBI) and malignant middle cerebral artery infarction (MMCAI) requiring craniotomy. DESIGN A descriptive observational study was carried out during 19 months. SETTING Neurocritical patients. PATIENTS Sixteen patients were included: 9 with MMCAI and 7 with moderate or severe TBI, requiring surgical treatment. INTERVENTIONS A 6-electrode subdural electrocorticographic (ECoG) strip was placed onto the perilesional cortex. MAIN VARIABLES OF INTEREST An analysis was made of the time profile and the number and duration of CSD and CSD-like episodes recorded from the ECoGs. RESULTS Of the 16 patients enrolled, 9 presented episodes of CSD or CSD-like phenomena, of highly variable frequency and duration. CONCLUSIONS Episodes of CSD and CSD-like phenomena are frequently detected in the ischemic penumbra and/or traumatic cortical regions of patients with MMCAI who require decompressive craniectomy or of patients with contusional TBI.
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Affiliation(s)
- M Sueiras
- Servicio de Neurofisiología, Hospital Universitario Vall d'Hebron, Barcelona, España; Unidad de Investigación de Neurotraumatología y Neurocirugía (UNINN), Hospital Universitario Vall d'Hebron, Institut Fundació de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - J Sahuquillo
- Unidad de Investigación de Neurotraumatología y Neurocirugía (UNINN), Hospital Universitario Vall d'Hebron, Institut Fundació de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España; Servicio de Neurocirugía, Hospital Universitario Vall d'Hebron, Barcelona, España.
| | - B García-López
- Servicio de Neurofisiología, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Á Sánchez-Guerrero
- Unidad de Investigación de Neurotraumatología y Neurocirugía (UNINN), Hospital Universitario Vall d'Hebron, Institut Fundació de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - M A Poca
- Unidad de Investigación de Neurotraumatología y Neurocirugía (UNINN), Hospital Universitario Vall d'Hebron, Institut Fundació de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España; Servicio de Neurocirugía, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - E Santamarina
- Servicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - M Riveiro
- Unidad de Investigación de Neurotraumatología y Neurocirugía (UNINN), Hospital Universitario Vall d'Hebron, Institut Fundació de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España; Unidad de Cuidados Intensivos de Neurotraumatología, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - M Fabricius
- Department of Clinical Neurophysiology, Glostrup Hospital, Copenhagen, Dinamarca
| | - A J Strong
- Department of Neurosurgery, King's College, London, Reino Unido
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Sierra-Marcos A, Toledo M, Quintana M, Edo M, Centeno M, Santamarina E, Sueiras M, Rovira R, Salas-Puig J, Alvarez-Sabin J. Diagnosis of epileptic syndrome after a new onset seizure and its correlation at long-term follow-up: Longitudinal study of 131 patients from the emergency room. Epilepsy Res 2011; 97:30-6. [DOI: 10.1016/j.eplepsyres.2011.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 06/01/2011] [Accepted: 06/26/2011] [Indexed: 10/18/2022]
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Sagalés T, Minoves T, Sueiras M, Romero O, Cordoba J. 160 Sleep alterations in hepatic subclinical encephalopathy. Int J Psychophysiol 1998. [DOI: 10.1016/s0167-8760(98)90160-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sueiras M, González N, Rovira R, Padró L. [Usefulness of the EEG recording in the diagnosis of cyclosporin A-induced encephalopathy]. Rev Neurol 1998; 26:766-9. [PMID: 9634664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Cyclosporine A is one of the immunosuppressors most frequently used to prevent transplant rejection. Neurotoxicity is one of the complications often associated with it. These complications include acute encephalopathy, lethargy, confusion state, tremor, headache, motor disorders, visual changes and epileptic crises amongst others, even when blood levels are at what are considered to be 'therapeutic' levels. CLINICAL CASES We present the EEG anomalies found in 3 transplant patients (two liver transplants and on double lung transplant) to whom cyclosporin A had been given and who presented with status epilepticus. The EEG recordings showed paroxystic discharges of focal onset in the temporo-occipital areas. They were mainly correlated with the clinical findings of oculomotor and eyelid disorders. CONCLUSION The topography of the neurophysiological findings supports--as do the other clinico-radiological findings--localization preferably to the posterior areas of cerebral dysfunction associated with cyclosporin A. Although the physiopathological origin of the encephalopathy of patients treated with cyclosporin A seems to correspond to multiple factors, we wish to point out the diagnostic usefulness of the identification of EEG changes localized to the temporo-occipital areas in the recognition of the neurotoxic syndrome in these patients.
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Affiliation(s)
- M Sueiras
- Servicio de Neurologia, Sección de Neurofisiología Clínica. Hospital Creu Roja de Barcelona, España
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