Abstracts

The estimated incidence of status epilepticus (SE) is 60 cases per 100,000 population per year. Diagnosis of convulsive SE (CSE) is usually obvious, but nonconvulsive SE (NCSE) is frequently missed or mistaken for many other conditions. Therefore, any study concerning prevalence or incidence of SE may come to underestimated figures due to difficulties in diagnosis. The objective of this study is to report the incidence of SE in a private general hospital in S[atilde]o Paulo, Brazil, along a period of two consecutive years, and to describe the clinical and electrographic characteristics in each case. Albert Einstein Hospital, a large private general hospital in S[atilde]o Paulo, Brazil, with over 500 beds including 40 beds in the intensive care unit, holds approximately 30,000 medical procedures each year. Charts of all patients who received EEG diagnosis of [apos]status epilepticus[apos], [apos]repetitive seizures[apos], [apos]clinical seizure[apos], or [apos]electrographic seizure[apos] along a period of 2 years (2002 and 2003) at the Division of Neurophysiology were reviewed. This period was chosen because most of the EEGs have been recorded on digital equipment since 2002, and were hence available for review. SE was defined as continuous or almost continuous EEG seizure activity for over 30 minutes with unequivocal impairment of consciousness and/or other clinical manifestations. Descriptions of the EEG exams were taken note, and all the available records were reviewed. Electrographic patterns were classified according to criteria proposed by Treiman [italic]et al[/italic]. In two years 14 episodes of SE in 13 patients were identified. In 11 of the 14 episodes the ictal pattern was continuous epileptic discharges. There were 2 cases of recurrent seizures and 1 case of merging seizures. In three cases subtle motor manifestations were observed; the remaining constituted cases of NCSE. No cases of CSE were diagnosed with EEG. There was only one EEG recording showing unequivocal focal features; all others showed generalized epileptic discharges. SE was less common than expected. Patients with CSE and patients with possible NCSE may have been treated before being submitted to EEG examination, thus reducing the number of documented cases. Only one EEG record showed focal discharges; in some cases of generalized discharges a focal onset may have been missed. No cases of CSE were diagnosed by EEG, most likely because these patients were treated promptly, and EEG performed after cessation of overt convulsive seizures. Finally, SE, at least in its nonconvulsive presentations, is frequently overlooked; this fact cannot be disregarded in this study. (Supported by Teaching and Research Institute, Hospital Israelita Albert Einstein)