Status epilepticus: review on diagnosis, monitoring and treatment

Abstract

Status epilepticus (SE) is a frequent neurological emergency associated with high morbidity and mortality. According to the new ILAE 2015 definition, SE results either from the failure of the mechanisms responsible for seizure termination or initiation, leading to abnormally prolonged seizures. The definition has different time points for convulsive, focal and absence SE. Time is brain. There are changes in synaptic receptors leading to a more proconvulsant state and increased risk of brain lesion and sequelae with long duration. Management of SE must include three pillars: stop seizures, stabilize patients to avoid secondary lesions and treat underlying causes. Convulsive SE is defined after 5 minutes and is a major emergency. Benzodiazepines are the initial treatment, and should be given fast and an adequate dose. Phenytoin/fosphenytoin, levetiracetam and valproic acid are evidence choices for second line treatment. If SE persists, anesthetic drugs are probably the best option for third line treatment, despite lack of evidence. Midazolam is usually the best initial choice and barbiturates should be considered for refractory cases. Nonconvulsive status epilepticus has a similar initial approach, with benzodiazepines and second line intravenous (IV) agents, but after that, aggressiveness should be balanced considering risk of lesion due to seizures and medical complications caused by aggressive treatment. Usually, the best approach is the use of sequential IV antiepileptic drugs (oral/tube are options if IV options are not available). EEG monitoring is crucial for diagnosis of nonconvulsive SE, after initial control of convulsive SE and treatment control. Institutional protocols are advised to improve care.

RESUMO

O estado de mal epiléptico (EME) é uma emergência frequente, com alta morbi-mortalidade. Segundo nova definição da ILAE de 2015, EME acontece pela falha dos mecanismos responsáveis pelo término ou início das crises, sendo anormalmente prolongadas. Pela definição existem diferentes tempos entre EME convulsivo, focal e ausência. Tempo é cérebro. Ocorrem alterações nos receptores sinápticos, levando estado mais pró-convulsivante, com aumento risco de lesão cerebral e sequelas. O manejo do EME deve incluir três pilares: parar a crise, estabilizar o paciente para evitar lesão secundária e tratar a etiologia. EME convulsivo é definido quando duração é maior que 5 minutos e trata-se grande emergência. Os benzodiazepínicos são o tratamento inicial, devem ser administrados rapidamente e na dose adequada. Fenitoína/fosfenitoína, levetiracetam e ácido valpróico são opções com evidência para tratamento de segunda linha. Se EME persistir, uso dos anestésicos é provavelmente a melhor opção como terceira linha tratamento, apesar da falta de evidências adequadas. O midazolam costuma ser a melhor escolha inicial e os barbitúricos devem ser considerados para casos refratários. O EME não convulsivo tem abordagem inicial semelhante, com benzodiazepínicos e agentes segunda linha, mas após, a agressividade deve ser equilibrada considerando risco de lesão pelas crises e complicações pelo tratamento agressivo. A abordagem sugerida é uso de fármacos IV sequenciais (via oral/tubo quando opções IV não disponíveis). A monitorização por EEG é fundamental para o diagnóstico do EME não convulsivo, após controle inicial EME convulsivo e para controle do tratamento. Protocolos institucionais são recomendados.

Keyword:

Status Epilepticus - Diagnosis - Monitoring - Electroencephalography - Therapeutics

Palavras-chave:

Estado Epiléptico - Diagnóstico - Monitoramento - Eletroencefalografia - Terapêutica

Authors’ contributions:

LFP: participated in the design, elaboration and review of the article; JPSO, AMM: participated in the elaboration and review of the article.

Publication History

Received: 15 March 2022

Accepted: 29 April 2022

Article published online:
06 February 2023

• References

• 1 Hesdorffer DC, Logroscino G, Cascino G, Annegers JF, Hauser WA. Incidence of status epilepticus in Rochester, Minnesota, 1965-1984. Neurology 1998; 50 (03) 735-741 https://doi.org/10.1212/wnl.50.3.735
• 2 DeLorenzo RJ, Hauser WA, Towne AR, Boggs JG, Pellock JM, Penberthy L. et al. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology 1996; 46 (04) 1029-1035 https://doi.org/10.1212/wnl.46.4.1029
• 3 Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S. et al. A definition and classification of status epilepticus - Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia 2015; 56 (10) 1515-1523 https://doi.org/10.1111/epi.13121
• 4 Nair PP, Kalita J, Misra UK. Status epilepticus: why, what, and how. J Postgrad Med 2011; 57 (03) 242-252 https://doi.org/10.4103/0022-3859.81807
• 5 Theodore WH, Porter RJ, Albert P, Kelley K, Bromfield E, Devinsky O. et al. The secondarily generalized tonic-clonic seizure: a videotape analysis. Neurology 1994; 44 (08) 1403-1407 https://doi.org/10.1212/wnl.44.8.1403
• 6 Treiman DM, Meyers PD, Walton NY, Collins JF, Colling C, Rowan AJ. et al. A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med 1998; 339 (12) 792-798 https://doi.org/10.1056/NEJM199809173391202
• 7 Alldredge BK, Gelb AM, Isaacs SM, Corry MD, Allen F, Ulrich S. et al. A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med 2001; 345 (09) 631-637 https://doi.org/10.1056/NEJMoa002141
• 8 Glauser T, Shinnar S, Gloss D, Alldredge B, Arya R, Bainbridge J. et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the guideline Committee of the American Epilepsy Society. Epilepsy Curr 2016; 16 (01) 48-61 https://doi.org/10.5698/1535-7597-16.1.48
• 9 Silbergleit R, Durkalski V, Lowenstein D, Conwit R, Pancioli A, Palesch Y. et al. Intramuscular versus intravenous therapy for prehospital status epilepticus. N Engl J Med 2012; 366 (07) 591-600 https://doi.org/10.1056/NEJMoa1107494
• 10 Kapur J, Elm J, Chamberlain JM, Barsan W, Cloyd J, Lowenstein D. et al. Randomized trial of three anticonvulsant medications for status epilepticus. N Engl J Med 2019; 381 (22) 2103-2113 https://doi.org/10.1056/NEJMoa1905795
• 11 Mayer SA, Claassen J, Lokin J, Mendelsohn F, Dennis LJ, Fitzsimmons B-F. Refractory status epilepticus: frequency, risk factors, and impact on outcome. Arch Neurol 2002; 59 (02) 205-210 https://doi.org/10.1001/archneur.59.2.205
• 12 Holtkamp M, Othman J, Buchheim K, Meierkord H. Predictors and prognosis of refractory status epilepticus treated in a neurological intensive care unit. J Neurol Neurosurg Psychiatry 2005; 76 (04) 534-539 https://doi.org/10.1136/jnnp.2004.041947
• 13 Abend NS, Dlugos DJ. Treatment of refractory status epilepticus: literature review and a proposed protocol. Pediatr Neurol 2008; 38 (06) 377-390 https://doi.org/10.1016/j.pediatrneurol.2008.01.001
• 14 Ferlisi M, Hocker S, Grade M, Trinka E, Shorvon S. International Steering Committee of the StEp Audit. Preliminary results of the global audit of treatment of refractory status epilepticus. Epilepsy Behav 2015; 49: P318-P324 https://doi.org/10.1016/j.yebeh.2015.04.010
• 15 Mirrakhimov AE, Voore P, Halytskyy O, Khan M, Ali AM. Propofol infusion syndrome in adults: a clinical update. Crit Care Res Pract 2015; 2015: 260385-260385 https://doi.org/10.1155/2015/260385
• 16 Rossetti AO, Logroscino G, Bromfield EB. Refractory status epilepticus: effect of treatment aggressiveness on prognosis. Arch Neurol 2005; 62 (11) 1698-1702 https://doi.org/10.1001/archneur.62.11.1698
• 17 Zeiler FA, Teitelbaum J, Gillman LM, West M. NMDA antagonists for refractory seizures. Neurocrit Care 2014; 20 (03) 502-513 https://doi.org/10.1007/s12028-013-9939-6
• 18 Ferlisi M, Shorvon S. The outcome of therapies in refractory and super-refractory convulsive status epilepticus and recommendations for therapy. Brain 2012; 135 (08) 2314-2328 https://doi.org/10.1093/brain/aws091
• 19 Brophy GM, Bell R, Claassen J, Alldredge B, Bleck TP, Glauser T. et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care 2012; 17 (01) 3-23 https://doi.org/10.1007/s12028-012-9695-z
• 20 DeLorenzo RJ, Waterhouse EJ, Towne AR, Boggs JG, Ko D, DeLorenzo GA. et al. Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia 1998; 39 (08) 833-840 https://doi.org/10.1111/j.1528-1157.1998.tb01177.x
• 21 Nabbout R, Mazzuca M, Hubert P, Peudennier S, Allaire C, Flurin V. et al. Efficacy of ketogenic diet in severe refractory status epilepticus initiating fever induced refractory epileptic encephalopathy in school age children (FIRES). Epilepsia 2010; 51 (10) 2033-2037 https://doi.org/10.1111/j.1528-1167.2010.02703.x
• 22 Nam SH, Lee BL, Lee CG, Yu HJ, Joo EY, Lee J. et al. The role of ketogenic diet in the treatment of refractory status epilepticus. Epilepsia 2011; 52 (11) e181-e184 https://doi.org/10.1111/j.1528-1167.2011.03289.x
• 23 Alexopoulos A, Lachhwani DK, Gupta A, Kotagal P, Harrison AM, Bingaman W. et al. Resective surgery to treat refractory status epilepticus in children with focal epileptogenesis. Neurology 2005; 64 (03) 567-570 https://doi.org/10.1212/01.WNL.0000150580.40019.63
• 24 Krsek P, Tichý M, Belsan T, Zámecník J, Paulas L, Faladová L. et al. Life-saving epilepsy surgery for status epilepticus caused by cortical dysplasia. Epileptic Disord 2002; 4 (03) 203-208
• 25 De Herdt V, Waterschoot L, Vonck K, Dermaut B, Verhelst H, Van Coster R. et al. Vagus nerve stimulation for refractory status epilepticus. Eur J Paediatr Neurol 2009; 13 (03) P286-P289 https://doi.org/10.1016/j.ejpn.2008.05.004
• 26 Sierra-Marcos A, Maestro I, Rodríguez-Osorio X, Miró J, Donaire A, Aparicio J. et al. Successful outcome of episodes of status epilepticus after vagus nerve stimulation: a multicenter study. Eur J Neurol 2012; 19 (09) 1219-1223 https://doi.org/10.1111/j.1468-1331.2012.03707.x
• 27 Yazdi JS, Schumaker JA. Treatment of refractory status epilepticus with vagus nerve stimulator in an elderly patient. World Neurosurg 2016; 95 620 e1-e7 https://doi.org/10.1016/j.wneu.2016.08.017
• 28 Valentín A, Nguyen HQ, Skupenova AM, Agirre-Arrizubieta Z, Jewell S, Mullatti N. et al. Centromedian thalamic nuclei deep brain stimulation in refractory status epilepticus. Brain Stimul 2012; 5 (04) P594-P598 https://doi.org/10.1016/j.brs.2011.10.002
• 29 Lee C-Y, Lim S-N, Wu T, Lee S-T. Successful treatment of refractory status epilepticus using anterior thalamic nuclei deep brain stimulation. World Neurosurg 2017; 99: 14-18 https://doi.org/10.1016/j.wneu.2016.11.097
• 30 Liu A, Pang T, Herman S, Pascual-Leone A, Rotenberg A. Transcranial magnetic stimulation for refractory focal status epilepticus in the intensive care unit. Seizure 2013; 22 (10) P893-P896 https://doi.org/10.1016/j.seizure.2013.06.014
• 31 VanHaerents S, Herman ST, Pang T, Pascual-Leone A, Shafi MM. Repetitive transcranial magnetic stimulation; A cost-effective and beneficial treatment option for refractory focal seizures. Clin Neurophysiol 2015; 126 (09) 1840-1842 https://doi.org/10.1016/j.clinph.2014.12.004
• 32 Zeiler FA, Matuszczak M, Teitelbaum J, Gillman LM, Kazina CJ. Magnesium sulfate for non-eclamptic status epilepticus. Seizure 2015; 32: P100-P108 https://doi.org/10.1016/j.seizure.2015.09.017
• 33 Rosemergy I, Adler J, Psirides A. Cannabidiol oil in the treatment of super refractory status epilepticus. A case report. Seizure 2016; 35: P56-P58 https://doi.org/10.1016/j.seizure.2016.01.009
• 34 Legriel S, Lemiale V, Schenck M, Chelly J, Laurent V, Daviaud F. et al. Hypothermia for neuroprotection in convulsive status epilepticus. N Engl J Med 2016; 375 (25) 2457-2467 https://doi.org/10.1056/NEJMoa1608193
• 35 Horváth L, Fekete I, Molnár M, Válóczy R, Márton S, Fekete K. The outcome of status epilepticus and long-term follow-up. Front Neurol 2019; 10: 427-427 https://doi.org/10.3389/fneur.2019.00427
• 36 Alvarez V, Westover MB, Drislane FW, Dworetzky BA, Curley D, Lee JW. et al. Evaluation of a clinical tool for early etiology identification in status epilepticus. Epilepsia 2014; 55 (12) 2059-2068 https://doi.org/10.1111/epi.12852
• 37 Davis R, Dalmau J. Autoimmunity, seizures, and status epilepticus. Epilepsia 2013; Sep 3;54(6 Suppl 6): 46-49 https://doi.org/10.1111/epi.12276
• 38 Fung EL, Fung BB. Subcommittee on the Consensus Statement of the Hong Kong Epilepsy Society. Review and update of the Hong Kong Epilepsy Guideline on status epilepticus. Hong Kong Med J 2017; 23 (01) 67-73 https://doi.org/10.12809/hkmj166025
• 39 Hirsch LJ, Gaspard N, van Baalen A, Nabbout R, Demeret S, Loddenkemper T. et al. Proposed consensus definitions for new-onset refractory status epilepticus (NORSE), febrile infection-related epilepsy syndrome (FIRES), and related conditions. Epilepsia 2018; 59 (04) 739-744 https://doi.org/10.1111/epi.14016
• 40 Gaspard N, Hirsch LJ, Sculier C, Loddenkemper T, van Baalen A, Lancrenon J. et al. New-onset refractory status epilepticus (NORSE) and febrile infection-related epilepsy syndrome (FIRES): state of the art and perspectives. Epilepsia 2018; 59 (04) 745-752 https://doi.org/10.1111/epi.14022
• 41 Reuber M, Pukrop R, Mitchell AJ, Bauer J, Elger CE. Clinical significance of recurrent psychogenic nonepileptic seizure status. J Neurol 2003; 250 (11) 1355-1362 https://doi.org/10.1007/s00415-003-0224-z
• 42 Seneviratne U, Low ZM, Low ZX, Hehir A, Paramaswaran S, Foong M. et al. Medical health care utilization cost of patients presenting with psychogenic nonepileptic seizures. Epilepsia 2019; 60 (02) 349-357 https://doi.org/10.1111/epi.14625
• 43 De Paola L, Terra VC, Silvado CE, Teive HAG, Palmini A, Valente KD. et al. Improving first responders' psychogenic nonepileptic seizures diagnosis accuracy: development and validation of a 6-item bedside diagnostic tool. Epilepsy Behav 2016; 54: P40-P46 https://doi.org/10.1016/j.yebeh.2015.10.025
• 44 Zaccara G, Citerio G, Del Gaudio A, Ferlisi M, Pugliese FR, Toni D. Clinical pathways of epileptic seizures and status epilepticus: results from a survey in Italy. Neurol Sci 2020; 41 (06) 1571-1575 https://doi.org/10.1007/s10072-020-04270-3
• 45 Husain AM, Horn GJ, Jacobson MP. Non-convulsive status epilepticus: usefulness of clinical features in selecting patients for urgent EEG. J Neurol Neurosurg Psychiatry 2003; 74 (02) 189-191 https://doi.org/10.1136/jnnp.74.2.189
• 46 Kaplan PW. The clinical features, diagnosis, and prognosis of nonconvulsive status epilepticus. Neurologist 2005; 11 (06) 348-361 https://doi.org/10.1097/01.nrl.0000162954.76053.d2
• 47 Meierkord H, Holtkamp M. Non-convulsive status epilepticus in adults: clinical forms and treatment. Lancet Neurol 2007; 6 (04) P329-P339 https://doi.org/10.1016/S1474-4422(07)70074-1
• 48 Pinto LF, Gilmore EJ, Petroff OA, Sivaraju A, Rampal N, Hirsch LJ. et al. Cyclic seizures in critically ill patients: clinical correlates, DC recordings and outcomes. Clin Neurophysiol 2017; 128 (06) 1083-1090 https://doi.org/10.1016/j.clinph.2017.01.015
• 49 Kurtz P, Gaspard N, Wahl AS, Bauer RM, Hirsch LJ, Wunsch H. et al. Continuous electroencephalography in a surgical intensive care unit. Intensive Care Med 2014; 40 (02) 228-234 https://doi.org/10.1007/s00134-013-3149-8
• 50 Rosenthal ES. Seizures, status epilepticus, and continuous EEG in the intensive care unit. Continuum (Minneap Minn). 2021; 27 (05) 1321-1343 https://doi.org/10.1212/CON.2022s1132022s1131012
• 51 Baker AM, Yasavolian MA, Arandi NR. Nonconvulsive status epilepticus: overlooked and undertreated. Emerg Med Pract 2019; 21 (10) 1-24
• 52 Trinka E, Leitinger M. Which EEG patterns in coma are nonconvulsive status epilepticus?. Epilepsy Behav 2015; 49: P203-P222 https://doi.org/10.1016/j.yebeh.2015.05.005
• 53 Leitinger M, Trinka E, Gardella E, Rohracher A, Kalss G, Qerama E. et al. Diagnostic accuracy of the Salzburg EEG criteria for non-convulsive status epilepticus: a retrospective study. Lancet Neurol 2016; 15 (10) P1054-P1062 https://doi.org/10.1016/S1474-4422(16)30137-5
• 54 Domínguez AG, Montero RCM, Cid AD, Mazarro AJP, Bailly-Bailliere IR, Landete IMS. et al. Salzburg criteria, a useful tool in non-convulsive status epilepticus diagnosis: a retrospective study. Clin EEG Neurosci 2021; 52 (06) 422-426 https://doi.org/10.1177/1550059421991710
• 55 Hirsch LJ, Fong MWK, Leitinger M, LaRoche SM, Beniczky S, Abend NS. et al. American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology: 2021 version. J Clin Neurophysiol 2021; 38 (01) 1-29 https://doi.org/10.1097/WNP.2022s1132022s1130806
• 56 Towne AR, Pellock JM, Ko D, DeLorenzo RJ. Determinants of mortality in status epilepticus. Epilepsia 1994; 35 (01) 27-34 https://doi.org/10.1111/j.1528-1157.1994.tb02908.x
• 57 Neligan A, Shorvon SD. Prognostic factors, morbidity and mortality in tonic-clonic status epilepticus: a review. Epilepsy Res 2011; 93 (01) 1-10 https://doi.org/10.1016/j.eplepsyres.2010.09.003
• 58 Cheng JY. Latency to treatment of status epilepticus is associated with mortality and functional status. J Neurol Sci 2016; 370: P290-P295 https://doi.org/10.1016/j.jns.2016.10.004
• 59 Pohlmann-Eden B, Hoch DB, Cochius JI, Chiappa KH. Periodic lateralized epileptiform discharges--a critical review. J Clin Neurophysiol 1996; 13 (06) 519-530 https://doi.org/10.1097/00004691-199611000-00007
• 60 Struck AF, Westover MB, Hall LT, Deck GM, Cole AJ, Rosenthal ES. Metabolic correlates of the ictal-interictal continuum: FDG-PET during continuous EEG. Neurocrit Care 2016; 24 (03) 324-331 https://doi.org/10.1007/s12028-016-0245-y
• 61 Vespa P, Tubi M, Claassen J, Buitrago-Blanco M, McArthur D, Velazquez AG. et al. Metabolic crisis occurs with seizures and periodic discharges after brain trauma. Ann Neurol 2016; 79 (04) 579-590 https://doi.org/10.1002/ana.24606
• 62 Chong DJ, Hirsch LJ. Which EEG patterns warrant treatment in the critically ill? Reviewing the evidence for treatment of periodic epileptiform discharges and related patterns. J Clin Neurophysiol 2005; 22 (02) 79-91 https://doi.org/10.1097/01.wnp.0000158699.78529.af
• 63 Kaplan PW, Duckworth J. Confusion and SIRPIDs regress with parenteral lorazepam. Epileptic Disord 2011; 13 (03) 291-294 https://doi.org/10.1684/epd.2011.0463
• 64 Lee JW. EEG in the ICU: what should one treat, what not?. Epileptologie 2012; 29: 210-217
• 65 Bravo P, Vaddiparti A, Hirsch LJ. Pharmacotherapy for nonconvulsive seizures and nonconvulsive status epilepticus. Drugs 2021; 81 (07) 749-770 https://doi.org/10.1007/s40265-021-01502-4
• 66 Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology 2004; 62 (10) 1743-1748 https://doi.org/10.1212/01.wnl.0000125184.88797.62
• 67 Abend NS, Dlugos DJ, Hahn CD, Hirsch LJ, Herman ST. Use of EEG monitoring and management of non-convulsive seizures in critically ill patients: a survey of neurologists. Neurocrit Care 2010; 12 (03) 382-389 https://doi.org/10.1007/s12028-010-9337-2
• 68 Vespa PM, Nuwer MR, Nenov V, Ronne-Engstrom E, Hovda DA, Bergsneider M. et al. Increased incidence and impact of nonconvulsive and convulsive seizures after traumatic brain injury as detected by continuous electroencephalographic monitoring. J Neurosurg 1999; 91 (05) 750-760 https://doi.org/10.3171/jns.1999.91.5.0750
• 69 Pandian JD, Cascino GD, So EL, Manno E, Fulgham JR. Digital video-electroencephalographic monitoring in the neurological-neurosurgical intensive care unit: clinical features and outcome. Arch Neurol 2004; 61 (07) 1090-1094 https://doi.org/10.1001/archneur.61.7.1090
• 70 Vespa PM, Miller C, McArthur D, Eliseo M, Etchepare M, Hirt D. et al. Nonconvulsive electrographic seizures after traumatic brain injury result in a delayed, prolonged increase in intracranial pressure and metabolic crisis. Crit Care Med 2007; 35 (12) 2830-2836 https://doi.org/10.1097/00003246-200712000-00023
• 71 Krishnamurthy KB, Drislane FW. Depth of EEG suppression and outcome in barbiturate anesthetic treatment for refractory status epilepticus. Epilepsia 1999; 40 (06) 759-762 https://doi.org/10.1111/j.1528-1157.1999.tb00775.x
• 72 Claassen J, Hirsch LJ, Emerson RG, Mayer SA. Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: a systematic review. Epilepsia 2002; 43 (02) 146-153 https://doi.org/10.1046/j.1528-1157.2002.28501.x
• 73 Vespa P. Continuous EEG monitoring for the detection of seizures in traumatic brain injury, infarction, and intracerebral hemorrhage: “to detect and protect”. J Clin Neurophysiol 2005; 22 (02) 99-106 https://doi.org/10.1097/01.wnp.0000154919.54202.e0
• 74 Lee JW, LaRoche S, Choi H, Ruiz AAR, Fertig E, Politsky JM. et al. Development and feasibility testing of a critical care EEG monitoring database for standardized clinical reporting and multicenter collaborative research. J Clin Neurophysiol 2016; 33 (02) 133-140 https://doi.org/10.1097/WNP.2022s1132022s1130230
• 75 Ruiz AR, Vlachy J, Lee JW, Gilmore EJ, Ayer T, Haider HA. et al. Association of periodic and rhythmic electroencephalographic patterns with seizures in critically Ill patients. JAMA Neurol 2017; 74 (02) 181-188 https://doi.org/10.1001/jamaneurol.2016.4990
• 76 Kalamangalam GP, Pohlmann-Eden B. Ictal-interictal continuum. J Clin Neurophysiol 2018; 35 (04) 274-278 https://doi.org/10.1097/WNP.2022s1132022s1130447
• 77 Hill CE, Blank LJ, Thibault D, Davis KA, Dahodwala N, Litt B. et al. Continuous EEG is associated with favorable hospitalization outcomes for critically ill patients. Neurology 2019; 92 (01) e9-18 https://doi.org/10.1212/WNL.2022s1132022s1136689
• 78 Struck AF, Ustun B, Ruiz AR, Lee JW, LaRoche SM, Hirsch LJ. et al. Association of an electroencephalography-based risk score with seizure probability in hospitalized patients. JAMA Neurol 2017; 74 (12) 1419-1424 https://doi.org/10.1001/jamaneurol.2017.2459
• 79 Westover MB, Shafi MM, Bianchi MT, Moura LMVR, O'Rourke D, Rosenthal ES. et al. The probability of seizures during EEG monitoring in critically ill adults. Clin Neurophysiol 2015; 126 (03) 463-471 https://doi.org/10.1016/j.clinph.2014.05.037
• 80 Leitinger M, Beniczky S, Rohracher A, Gardella E, Kalss G, Qerama E. et al. Salzburg consensus criteria for non-convulsive status epilepticus--approach to clinical application. Epilepsy Behav 2015; 49: P158-P163 https://doi.org/10.1016/j.yebeh.2015.05.007
• 81 Struck AF, Tabaeizadeh M, Schmitt SE, Ruiz AR, Swisher CB, Subramaniam T. et al. Assessment of the validity of the 2HELPS2B score for Inpatient Seizure Risk Prediction. JAMA Neurol 2020; 77 (04) 500-507 https://doi.org/10.1001/jamaneurol.2019.4656