Non-Convulsive Status Epilepticus in Ischemic Stroke and its Impact on Prognosis

Background: Emerging data support a higher than previously thought incidence of Non-Convulsive Epileptic Activity in Ischemic Stroke Patients, which is an important consideration affecting prognosis.

Objectives: to determine frequency of non-convulsive status epilepticus (NCSE), in the form of continuous electrographic Seizures with no motor manifestations, in ischemic stroke patients and how it affects outcome.

Methods: We prospectively and consecutively studied 3168 patients with acute stroke, collected from January 2006 to December 2009. DEEG was done for every stroke patient within 24 hours of admission to ICU and repeated if his level of consciousness changed. We determined initial stroke severity, mortality, and outcome in survivors. Stroke severity was assessed, clinically and by imaging. Multiple logistic and linear regression outcome analyses included age, gender, stroke severity, atrial fibrillation, ischemic heart disease, blood glucose level, claudication, and hypertension.

Results: NCSE were detected in 197 (6.2 %) patients in the first EEG. With second EEG done after change in level of consciousness of 1054 patients, total number of patients showed NCSE increased to 579 (18.27 %). Patients with early NCSE Mortality rate is higher than that of late NCSE, Mortality rate is higher in patients with disturbed level of consciousness and no NCSE, than those with NCSE. ICU stay duration is shorter and clinical outcome is better for patients with disturbed level of consciousness and NCSE.

Conclusion: NCSE is a frequent finding in acute stroke, reaching 18%, Patients with stroke would benefit from an EEG. Early NCSE increase Mortality rate. Treating NCSE improves outcome.