title: Incidence of recurrent seizures following hospital discharge in patients with LPDs (PLEDs) and nonconvulsive seizures recorded on continuous EEG in the critical care setting.
abstract: OBJECTIVE
  Continuous EEG (cEEG) has helped to identify nonconvulsive seizures (NCS) and nonconvulsive status epilepticus (NCSE) along with lateralized periodic patterns (LPDs or PLEDs) in ICU patients with much higher frequency than previously appreciated, but understanding their implications may be more complex. The aim of this study was to investigate the incidence of recurrent seizures after hospital discharge and their associated factors in patients with PLEDs and NCS in the critical care setting.
  
  
  METHODS
  After IRB approval, we used our EEG reporting database to find 200 consecutive patients who had PLEDs and/or NCSs on cEEG. Patients with less than 3 months of follow-up were excluded. Remaining patients were divided into three groups: PLEDs+Seizure (NCS/NCSE), PLEDs only, and Seizures (NCS/NCSE) only. Medical records were reviewed to gather demographical and clinical details. Univariate data analysis was done using JMP 9.0 (Marlow, Buckinghamshire, UK).
  
  
  RESULTS
  There were 51 patients in 'PLEDs+Seizure' group, 45 in 'PLEDs only' group, and 22 in 'Seizure only' group. Ischemic stroke, hemorrhage, and tumors were the top three etiologies. Nearly 47% of our study population had postdischarge seizures during a mean follow-up period of 11.9 (+/-6) months. We found that 24.4% of patients in the PLEDs only group had seizures after discharge, which increased to 60.7% if they had seizures as well during their ICU stay. Slightly more than 52% of patients had a postdischarge EEG, of which, 59% was in the form of inpatient cEEG during a rehospitalization, accounting for 30.5% of the total study population. It was an indicator of high readmission rates in this population.
  
  
  CONCLUSIONS
  Almost every other patient with PLEDs and/or NCS on cEEG had seizures after ICU discharge. A quarter of patients on cEEG in the ICU with PLEDs alone had seizures after discharge, and after excluding prior epilepsy, 17% of patients with PLEDs had seizures on follow-up. This was dramatically increased with the recording of PLEDs with NCS, with 60% of patients having seizures after discharge from the ICU and 48% of patients after excluding prior epilepsy. Patients with NCS on cEEG alone had 63% chance of seizure recurrence that dropped to 38% with exclusion of prior epilepsy. Future studies are needed to define the postdischarge outcomes including seizure recurrence in this patient population. This article is part of a Special Issue entitled "Status Epilepticus".
authors.affiliation: Cleveland Clinic Epilepsy Center, 9500 Euclid Ave., S51, Cleveland, OH 44195, USA.
authors.forename: Vineet
authors.initials: V
authors.lastname: Punia
authors.affiliation: Cleveland Clinic Epilepsy Center, 9500 Euclid Ave., S51, Cleveland, OH 44195, USA.
authors.forename: Camilo Gracia
authors.initials: CG
authors.lastname: Garcia
authors.affiliation: Cleveland Clinic Epilepsy Center, 9500 Euclid Ave., S51, Cleveland, OH 44195, USA. Electronic address: hantuss@ccf.org.
authors.forename: Stephen
authors.initials: S
authors.lastname: Hantus
mesh_terms: D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D002545:Brain Ischemia / Q000150:complications; D001932:Brain Neoplasms / Q000150:complications; D003422:Critical Care; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D012008:Recurrence; D012640:Seizures / Q000453:epidemiology* / Q000209:etiology; D013226:Status Epilepticus / Q000453:epidemiology* / Q000209:etiology; D020521:Stroke / Q000150:complications; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants
keywords: LPDs; Nonconvulsive seizure; PLEDs; Recurrent seizure; cEEG