Introduction

Non-convulsive seizures (NCSz) and non-convulsive status epilepticus (NCSE) are frequent in critically ill patients. Specific temporal thresholds to define both are lacking and may be needed to guide appropriate treatment.

Method

Retrospective review of 995 NCSz captured during continuous EEG monitoring of 111 consecutive critically ill patients. Seizures were classified according to their type and underlying etiology (acute or progressive brain injury, seizure-related disorders and acute medical illness). Median and interquartile ranges [IQR] were calculated. Suggested temporal threshold for NCSE was defined as the 95 percentile of seizure duration.

Results

Most (69%) patients had an underlying acute or progressive brain injury. The 95 percentile of seizure duration was 518 s, overall, with variation according to underlying etiology (median 86 [47–137] s for brain injury, 73 [45–115] s for seizure-related disorders, and 92 [58–223] s for acute medical illness, respectively; p = 0.0025; 95 percentile 424, 304, and 1725 s, respectively). Forty-one (37%) patients were comatose and had significantly longer seizures than non-comatose patients (median 99 [49–167] vs. 73 [46–123] s; p < 0.001; 95 percentile: 600 vs 444 s).

Conclusion

To define NCSE, a temporal threshold of 10 min in critically ill patients with a primary neurological diagnosis can be applied, while a temporal threshold of 30 min might be suitable for patients with an underlying acute medical illness.

中文翻译：

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危重患者非惊厥发作的持续时间

 介绍

非惊厥性癫痫发作（NCSz）和非惊厥性癫痫持续状态（NCSE）在危重患者中很常见。缺乏定义两者的具体时间阈值，可能需要指导适当的治疗。

 方法

对 111 名连续危重患者的连续脑电图监测期间捕获的 995 个 NCSz 进行回顾性审查。癫痫发作根据其类型和潜在病因（急性或进行性脑损伤、癫痫相关疾病和急性内科疾病）进行分类。计算中位数和四分位数范围 [IQR]。建议的 NCSE 时间阈值定义为癫痫发作持续时间的 95%。

 结果

大多数（69%）患者患有潜在的急性或进行性脑损伤。总体而言，癫痫发作持续时间的 95% 为 518 秒，根据潜在病因的不同而有所不同（脑损伤的中位时间为 86 [47–137] 秒，癫痫相关疾病的中位时间为 73 [45–115] 秒，癫痫发作相关疾病的中位时间为 92 [58–223] 秒。 ] s 分别表示急性医疗疾病； p = 0.0025；95 百分位数分别为 424、304 和 1725 s）。四十一名 (37%) 患者处于昏迷状态，且癫痫发作时间明显长于非昏迷患者（中位时间 99 [49–167] 与 73 [46–123] 秒； p < 0.001；95 百分位：600 秒与 444 秒） 。

 结论

为了定义 NCSE，对于有原发性神经系统诊断的危重患者，可以采用 10 分钟的时间阈值，而 30 分钟的时间阈值可能适合患有潜在急性内科疾病的患者。