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Observational Study
. 2023 Apr 25;100(17):e1763-e1775.
doi: 10.1212/WNL.0000000000206838. Epub 2023 Mar 6.

Comparing Patients With Isolated Seizures and Status Epilepticus in Intensive Care Units: An Observational Cohort Study

Anna S Wagner  1 , Sira M Baumann  1 , Saskia Semmlack  1 , Anja I Frei  1 , Stephan Rüegg  1 , Sabina Hunziker  1 , Stephan Marsch  1 , Raoul Sutter  2
Affiliations
Observational Study

Comparing Patients With Isolated Seizures and Status Epilepticus in Intensive Care Units: An Observational Cohort Study

Anna S Wagner et al. Neurology. .

Abstract

Background and objectives: To assess the frequency of status epilepticus (SE) among seizing critically ill adult patients and to determine clinical differences between patients with isolated seizures and patients with SE in the intensive care unit (ICU).

Methods: From 2015 to 2020, all consecutive adult ICU patients at a Swiss tertiary care center with isolated seizures or SE as reported by intensivists and/or consulting neurologists were identified by screening of all digital medical, ICU, and EEG records. Patients aged <18 years and patients with myoclonus due to hypoxic-ischemic encephalopathy but without seizures on EEG were excluded. The frequency of isolated seizures, SE, and clinical characteristics at seizure onset associated with SE were the primary outcomes. Uni- and multivariable logistic regression was performed to identify associations with the emergence of SE.

Results: Among 404 patients with seizures, 51% had SE. Compared with patients with isolated seizures, patients with SE had a lower median Charlson Comorbidity Index (CCI) (3 vs 5, p < 0.001), fewer fatal etiologies (43.6% vs 80.5%, p < 0.001), higher median Glasgow coma scores (7 vs 5, p < 0.001), fever more frequently (27.5% vs 7.5%, p < 0.001), shorter median ICU and hospital stay (ICU: 4 vs 5 days, p = 0.039; hospital stay: 13 vs 15 days, p = 0.045), and recovered to premorbid function more often (36.8% vs 17%, p < 0.001). Multivariable analyses revealed decreased odds ratios (ORs) for SE with increasing CCI (OR 0.91, 95% CI 0.83-0.99), fatal etiology (OR 0.15, 95% CI 0.08-0.29), and epilepsy (OR 0.32, 95% CI 0.16-0.63). Systemic inflammation was an additional association with SE after excluding patients with seizures as the reason for ICU admission (ORfor CRP 1.01, 95% CI 1.00-1.01; ORfor fever 7.35, 95% CI 2.84-19.0). Although fatal etiologies and increasing CCI remained associated with low odds for SE after excluding anesthetized patients and hypoxic-ischemic encephalopathy, inflammation remained associated in all subgroups except patients with epilepsy.

Discussion: Among all ICU patients with seizures, SE emerged frequently and seen in every second patient. Besides the unexpected low odds for SE with higher CCI, fatal etiology, and epilepsy, the association of inflammation with SE in the critically ill without epilepsy represents a potential treatment target and deserves further attention.

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Conflict of interest statement

A.S. Wagner, S.M. Baumann, S. Semmlack, and A. Frei report no disclosures. S. Rüegg received unconditional research grants from UCB Pharma and received honoraria from serving on the scientific advisory boards of Arvelle, Eisai, and UCB Pharma and from serving as a consultant for Arvelle, Eisai, Pfizer, Novartis, Sandoz, and UCB Pharma; he received funding from UCB Pharma and the Swiss National Science Foundation Grants (grant number 320030_169379/1 and coapplicant for grants numbers 33CM30_125115/1 and 33CM30_140338/1); he disclosed that he is an editor of the Swiss EEG Bulletin (payments from UCB). S. Hunziker reports to be supported by the Swiss National Foundation (Ref 10001C_192850/1 and 10531C_182422), the Bangerter-Rhyner Foundation (8472/HEG-DSV), and the Swiss Society of General Internal Medicine (SSGIM). S. Marsch reports no disclosures. R. Sutter received research grants from the Swiss National Foundation (No 320030_169379), the Research Fund of the University Basel, the Scientific Society Basel, and the Bangerter-Rhyner Foundation; received personal grants from UCB Pharma; and holds stocks from Novartis, Roche, Alcon, and Johnson & Johnson. Go to Neurology.org/N for full disclosures.

Figures

Figure 1
Figure 1. Flowchart
*All patients with seizures as the reason for ICU admission had transformed into status epilepticus. ICU = intensive care unit; SE = status epilepticus.
Figure 2
Figure 2. Comparison of Specific Etiologies Among Seizing ICU Patients With and Without Status Epilepticus
(A) Including ICU patients with seizures as the reason for admission or emerging during ICU stay and critical illness (i.e., total cohort); (B) restricted to patients with seizures during ICU stay and critical illness. Listed etiologies not mutually exclusive. ICU = intensive care unit; SE = status epilepticus; NS = not significant.
See this image and copyright information in PMC

Comment in

References

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    1. Wagner AS, Semmlack S, Frei A, Ruegg S, Marsch S, Sutter R. Seizures and risks for recurrence in critically ill patients: an observational cohort study. J Neurol. 2022;269(8):4185-4194. - PMC - PubMed
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