title: Spectrum of nonconvulsive status epilepticus in patients with cancer.
abstract: OBJECTIVE
  Determine incidence, clinical presentation, electrographic correlates, and outcome of nonconvulsive status epilepticus (NCSE) in cancer patients on whom an EEG was performed.
  
  
  METHODS
  Retrospective review of 947 EEG reports on 658 patients in whom any type of EEG was performed at Memorial Sloan-Kettering Cancer Center (July 2006 to March 2008). Using the Epilepsy Research Foundation criteria, patients were classified as definite or probable NCSE. Medical records were reviewed for diagnosis, causes of NCSE, response to treatment, and outcome. Mortality was determined for patients with NCSE.
  
  
  RESULTS
  Twenty-six episodes of NCSE were identified in 25 patients (25/658, 4%). Eleven patients had primary brain tumor, 12 patients systemic cancer, and two had both. At diagnostic EEG, 18 were awake, 3 were lethargic, and 5 patients were comatose. EEG revealed a seizure in 62% of the patients, periodic lateralized epileptiform discharges in 42%, and periodic epileptiform discharges in 7.7%. Neuroimaging revealed new intracranial pathology in 54% of the patients. Seventy-seven percent of the patients achieved control; 65% required ≥3 antiepileptic drugs, and 33% required intubation. Three patients died from NCSE.
  
  
  CONCLUSIONS
  In our cohort, awake NCSE was more common than comatose NCSE. Treatment was successful in patients with heterogeneous central nervous system disease. EEG evaluation should be considered in patients with cancer because NCSE is treatable despite a high prevalence of structural brain disease. Nonconvulsive status epilepticus control did not always require intubation and burst suppression, but frequently required three or more antiepileptic drugs.
authors.affiliation: Department of Neurology and Neuroscience, Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: Meredith
authors.initials: M
authors.lastname: Spindler
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Jacks
authors.forename: Xi
authors.initials: X
authors.lastname: Chen
authors.forename: Katherine
authors.initials: K
authors.lastname: Panageas
authors.forename: Lisa M
authors.initials: LM
authors.lastname: DeAngelis
authors.forename: Edward K
authors.initials: EK
authors.lastname: Avila
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D001921:Brain / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology*; D001932:Brain Neoplasms / Q000453:epidemiology / Q000556:secondary; D002648:Child; D002675:Child, Preschool; D003128:Coma / Q000503:physiopathology; D004569:Electroencephalography / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D053609:Lethargy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000473:pathology; D009369:Neoplasms / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000188:drug therapy / Q000503:physiopathology*; D013226:Status Epilepticus / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
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