Nonconvulsive status epilepticus after surgery for ruptured intracranial aneurysms: Incidence, associated factors, and impact on the outcome

• Published in: Clinical neurology and neurosurgery 2021-01, Vol.200, p.106298-106298, Article 106298
• Main Authors: Kikuta, Yoshichika, Kubota, Yuichi, Nakamoto, Hidetoshi, Chernov, Mikhail, Kawamata, Takakazu
• Format: Article
• Language: English
• Subjects: Anesthesia; Aneurysm; Aneurysmal subarachnoid hemorrhage; Aneurysms; Cardiovascular system; Coma; Convulsions & seizures; Diagnosis; EEG; Endovascular coiling; Epilepsy; Hospitals; Hydrocephalus; Incidence; Medical diagnosis; Medical imaging; Neurology; Nonconvulsive status epilepticus; Outcome; Patients; Subarachnoid hemorrhage; Surgery; Treatment; Veins & arteries
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2020.106298

•Nonconvulsive status epilepticus was revealed in !5 % of patients after surgery for ruptured intracranial aneurysm.•Nonconvulsive status epilepticus was diagnosed only after microsurgical clipping, but not after coiling, of the ruptured aneurysm.•Nonconvulsive status epilepticus was strongly associated with the poor clinical condition of patient at admission and high-grade SAH.•Patients diagnosed with the nonconvulsive status epilepticus required longer hospital stay and had less favorable disability outcomes.•Continuous EEG monitoring may be helpful for the timely diagnosis and treatment of nonconvulsive status epilepticus in high-risk patients. To evaluate the incidence of nonconvulsive status epilepticus (NCSE) after surgery for ruptured intracranial aneurysms, to define factors associated with this complication, and to determine its impact on the outcome. Clinical and neurophysiological data of 66 patients with aneurysmal subarachnoid hemorrhage (aSAH) who underwent continuous EEG (cEEG) monitoring after microsurgical clipping (53 cases) or endovascular coiling (13 cases) of the ruptured aneurysm were analyzed retrospectively. The diagnosis of NCSE was based on the American Clinical Neurophysiology Society and Salzburg Consensus criteria. NCSE was revealed in 10 patients (15 %), all of whom underwent craniotomy and aneurysm clipping. In comparison to the subgroup without NCSE, among those who were diagnosed with this complication there was a significantly greater proportion of men (70 % vs. 34 %; P = 0.041), cases with the Glasgow Coma Scale score at admission < 13 (90 % vs. 36 %; P = 0.004), the Hunt and Hess aSAH grades 3−5 (90 % vs. 45 %; P = 0.013), and hydrocephalus (70 % vs. 29 %; P = 0.044). In addition, they required a significantly longer hospital stay (medians, 62.5 vs. 39.5 days; P = 0.015) and showed trend for the lower rate of favorable disability outcomes (20 % vs. 54 %; P = 0.084). NCSE is encountered rather often after the microsurgical clipping of ruptured intracranial aneurysms, especially in severely disabled patients with high-grade aSAH and/or associated hydrocpephalus, and may significantly affect the clinical course and prolong recovery. cEEG monitoring may be helpful for timely diagnosis and treatment of this complication.