title: Non-convulsive status epilepticus and non-convulsive seizures in neurological ICU patients.
abstract: BACKGROUND
  Non-convulsive seizures (NCS) or non-convulsive status epilepticus (NCSE) has been reported in 8-20 % of critically ill patient populations, and delayed diagnosis and treatment of NCSE may lead to increased mortality. This study seeks to better understand the risk factors, characteristics, and outcome of NCS/NCSE in the neurological ICU.
  
  
  METHODS
  This is a prospective observational study, recruiting consecutive patients admitted to the adult neurological ICU with altered mental status. Patients with anoxic brain injury were excluded from the study. Data were collected and analyzed for prevalence of NCSE/NCS, EEG patterns, associated risk factors, treatment response, and final outcome.
  
  
  RESULTS
  NCSE/NCS was detected in 21 % of 170 subjects. Clinical seizures preceded EEG diagnosis of NCSE/NCS in 25 % of cases. Significant risk factors for NCSE/NCS were a past medical history of intracranial tumor, epilepsy, or meningitis/encephalitis, or MRI evidence of encephalomalacia. Subtle clinical findings such as twitching of oral or ocular muscles and eye deviations were found on exam in 50 % of the NCSE/NCS group. Mortality was increased in NCSE cases as 31 % of NCSE/NCS patients died compared to 14 % in non-NCSE/NCS group.
  
  
  CONCLUSIONS
  Specific clinical features along with history and imaging findings may be used to identify patients at high risk of NCSE/NCS in the neurological ICU.
authors.affiliation: Epilepsy Center of Excellence, Veterans Affairs Medical Center, Richmond, VA, USA, ikuko.laccheo@gmail.com.
authors.forename: Ikuko
authors.initials: I
authors.lastname: Laccheo
authors.forename: Hasan
authors.initials: H
authors.lastname: Sonmezturk
authors.forename: Amar B
authors.initials: AB
authors.lastname: Bhatt
authors.forename: Luke
authors.initials: L
authors.lastname: Tomycz
authors.forename: Yaping
authors.initials: Y
authors.lastname: Shi
authors.forename: Marianna
authors.initials: M
authors.lastname: Ringel
authors.forename: Gina
authors.initials: G
authors.lastname: DiCarlo
authors.forename: DeAngelo
authors.initials: D
authors.lastname: Harris
authors.forename: John
authors.initials: J
authors.lastname: Barwise
authors.forename: Bassel
authors.initials: B
authors.lastname: Abou-Khalil
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Haas
mesh_terms: D000328:Adult; D000368:Aged; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012640:Seizures / Q000175:diagnosis* / Q000453:epidemiology*; D013226:Status Epilepticus / Q000175:diagnosis* / Q000453:epidemiology*; D016896:Treatment Outcome