Clinical and laboratory predictors of electrographic status epilepticus in the neurological intensive care

Electrographic status epilepticus (ESE) is a clinical condition with high morbidity and mortality. Early diagnosis and treatment positively affect prognosis. There is a need to determine parameters that can help to identify patients who need urgent EEG in the intensive care unit (ICU) to detect ESE. In this study, we aimed to determine clinical, laboratory, and radiological parameters that may predict ESE.

Patients who underwent video-EEG monitoring (VEM) for possible ESE in our neurological ICU between 2009-2020, were identified from patient charts and VEM reports. We recorded demographic data, indication and duration of VEM, history of epilepsy, presence of convulsions before VEM, Glasgow coma scale (GCS) and Sequential Organ Failure Assessment (SOFA) scores, neurological examination findings, use of antiseizure medications (ASM) before VEM, brain MRI characteristics, routine EEG findings before VEM and blood parameters. These variables were compared statistically between patients with and without ESE (control group).

We included 32 ESE (13F; mean age 59.5 ± 15.7 years) and 160 non-ESE (83F; mean age 63.3 ± 17.4 years) patients. History of epilepsy (p = 0.020; OR = 8.906), epileptiform/ictal discharge in routine EEG (p = 0.001; OR = 17.498) and elevated serum lactate levels (p = 0.001; OR = 10.331) were associated with ESE after logistic regression analysis.

These results imply that some clinical symptoms, EEG findings, and blood values can be used to predict the presence of ESE in critical care patients. Prospective studies with more cases are needed to validate our findings.