Intravenous Benzodiazepines Predict Outcome in Epileptic Encephalopathies Suspected to Be Nonconvulsive Status Epilepticus.
Abstract number :
3.163
Submission category :
Year :
2000
Submission ID :
1763
Source :
www.aesnet.org
Presentation date :
12/2/2000 12:00:00 AM
Published date :
Dec 1, 2000, 06:00 AM
Authors :
George J Hart, Allan Krumholz, Nivea Ribas, Gregory Bergey, Elizabeth Barry, Lawrence G Seiden, Univ of Maryland, Baltimore, MD; Johns Hopkins Univ, Baltimore, MD.
RATIONALE: Recognition of nonconvulsive status epilepticus (NCSE) is important because such patients benefit from aggressive antiepileptic (AED) treatment. However, not all patients with "epileptic encephalopathies", defined as disorders with altered mental function and an epileptiform EEG, improve with AED therapy. This is presumably because of severe underlying brain disorders in some of these patients. We studied the value of intravenous (IV) benzodiazepines (BDZ) to predict outcome for these patients. METHODS: We reviewed all patients referred to the Neurology Service with epileptic encephalopathies suspected to be NCSE who received IV BDZs at a dose sufficient to abolish or significantly reduce the abnormal EEG pattern or until a maximum tolerated dose was reached. The clinical and EEG response, survival, recovery of consciousness, and functional outcome at hospital discharge were analyzed. RESULTS: We identified 62 patients. 22 (35%) had a clinical response with improvement in consciousness, and 40 (65%) were clinical nonresponders. Of the nonresponders 14 (35%) recovered consciousness and 22 (55%) survived. Of the survivors, 59% experienced severe dysfunction or a worse outcome. In contrast, the clinical responders had a statistically better outcome (p<.001). 100% survived and recovered consciousness and all had either a good (82%) or moderate (18%) recovery. EEG improvement was predictive of recovery of consciousness and functional recovery (p<.05), but not survival. CONCLUSIONS: Clinical and EEG responses to BDZs are valuable for predicting outcome and guiding therapy in patients with suspected NCSE.