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The Spectrum of Non-Convulsive Status Epilepticus in Patients with Cancer #MMPMID23912570
Spindler M; Jacks LM; Chen X; Panageas K; DeAngelis LM; Avila EK
J Clin Neurophysiol 2013[Aug]; 30 (4): 339-43 PMID23912570show ga
Purpose: Determine incidence, clinical presentation, electrographic correlates, and outcome of NCSE in cancer patients on whom an EEG was performed. Methods: Retrospective review of 947 EEG reports on 658 patients in whom any type of EEG was performed at Memorial Sloan-Kettering Cancer Center (July 2006 ? March 2008). Using the Epilepsy Research Foundation criteria, patients were classified as definite or probable NCSE. Medical records were reviewed for diagnosis, causes of NCSE, response to treatment, and outcome. Mortality was determined for patients with NCSE. Results: Twenty-six episodes of NCSE were identified in 25 patients (25/658, 4%). Eleven had a primary brain tumor, 12 systemic cancer and two both. At diagnostic EEG, 18 were awake, 3 lethargic, and 5 comatose. EEG revealed a seizure in 62%, PLEDs in 42%, PEDs in 7.7%. Neuroimaging revealed new intracranial pathology in 54%. Seventy-seven percent achieved control; 65% required ?3 AEDs, and 33% required intubation. Three patients died from NCSE. Discussion: In our cohort, awake NCSE was more common than comatose NCSE. Treatment was successful in patients with heterogeneous CNS disease. EEG evaluation should be considered in patients with cancer as NCSE is treatable despite a high prevalence of structural brain disease. NCSE control did not always require intubation and burst suppression, but frequently required three or more AEDs.