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Semin Neurol 2011; 31(2): 194-201
DOI: 10.1055/s-0031-1277987
© Thieme Medical Publishers

Seizures and Encephalopathy

Suzette M. LaRoche1
  • 1Emory University School of Medicine, Atlanta, Georgia
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Publication History

Publication Date:
17 May 2011 (online)

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ABSTRACT

There is a complex relationship between seizures and encephalopathy. Seizures alone without any underlying neurologic or medical illness can be the sole cause of encephalopathy. Often these patients have a history of epilepsy, in which case accurate diagnosis is straightforward. Acute neurologic conditions often contribute to encephalopathy, but also increase the risk of seizures—many of which are subclinical. In these scenarios, it can be difficult to determine whether the encephalopathy is caused by seizures, the underlying neurologic disorder, or both. In addition, systemic diseases are commonly associated with encephalopathy; they may also increase the risk of seizures, although less commonly than acute neurologic conditions, and therefore may go unrecognized. This review will examine common and uncommon causes of seizures in encephalopathic patients, typical clinical presentations as well as diagnosis and treatment.

KEYWORDS

Seizure - encephalopathy - nonconvulsive status epilepticus - electroencephalogram - EEG monitoring

REFERENCES

  • 1 DeLorenzo R J, Waterhouse E J, Towne A R et al.. Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus.  Epilepsia. 1998;  39 (8) 833-840
    CrossrefPubMedGoogle Scholar
  • 2 Privitera M, Hoffman M, Moore J L, Jester D. EEG detection of nontonic-clonic status epilepticus in patients with altered consciousness.  Epilepsy Res. 1994;  18 (2) 155-166
    CrossrefPubMedGoogle Scholar
  • 3 Towne A R, Waterhouse E J, Boggs J G et al.. Prevalence of nonconvulsive status epilepticus in comatose patients.  Neurology. 2000;  54 (2) 340-345
    CrossrefPubMedGoogle Scholar
  • 4 Claassen J, Mayer S A, Kowalski R G, Emerson R G, Hirsch L J. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients.  Neurology. 2004;  62 (10) 1743-1748
    CrossrefPubMedGoogle Scholar
  • 5 Jordan K G. Neurophysiologic monitoring in the neuroscience intensive care unit.  Neurol Clin. 1995;  13 (3) 579-626
    CrossrefPubMedGoogle Scholar
  • 6 Pandian J D, Cascino G D, So E L, Manno E, Fulgham J R. Digital video-electroencephalographic monitoring in the neurological-neurosurgical intensive care unit: clinical features and outcome.  Arch Neurol. 2004;  61 (7) 1090-1094
    CrossrefPubMedGoogle Scholar
  • 7 Vespa P. Continuous EEG monitoring for the detection of seizures in traumatic brain injury, infarction, and intracerebral hemorrhage: “to detect and protect.”  J Clin Neurophysiol. 2005;  22 (2) 99-106
    CrossrefPubMedGoogle Scholar
  • 8 Claassen J, Jetté N, Chum F et al.. Electrographic seizures and periodic discharges after intracerebral hemorrhage.  Neurology. 2007;  69 (13) 1356-1365
    CrossrefPubMedGoogle Scholar
  • 9 Claassen J, Hirsch L J, Frontera J A et al.. Prognostic significance of continuous EEG monitoring in patients with poor-grade subarachnoid hemorrhage.  Neurocrit Care. 2006;  4 (2) 103-112
    CrossrefPubMedGoogle Scholar
  • 10 Oddo M, Carrera E, Claassen J, Mayer S A, Hirsch L J. Continuous electroencephalography in the medical intensive care unit.  Crit Care Med. 2009;  37 (6) 2051-2056
    CrossrefPubMedGoogle Scholar
  • 11 Friedman D, Claassen J, Hirsch L J. Continuous electroencephalogram monitoring in the intensive care unit.  Anesth Analg. 2009;  109 (2) 506-523
    CrossrefPubMedGoogle Scholar
  • 12 Vespa P M, O'Phelan K, Shah M et al.. Acute seizures after intracerebral hemorrhage: a factor in progressive midline shift and outcome.  Neurology. 2003;  60 (9) 1441-1446
    CrossrefPubMedGoogle Scholar
  • 13 Wijdicks E F, Hijdra A, Young G B, Bassetti C L, Wiebe S. Quality Standards Subcommittee of the American Academy of Neurology . Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology 2006; 67(2):203–210. 
    PubMedGoogle Scholar
  • 14 Vespa P M, Miller C, McArthur D et al.. Nonconvulsive electrographic seizures after traumatic brain injury result in a delayed, prolonged increase in intracranial pressure and metabolic crisis.  Crit Care Med. 2007;  35 (12) 2830-2836
    CrossrefPubMedGoogle Scholar
  • 15 Vespa P M, McArthur D L, Xu Y et al.. Nonconvulsive seizures after traumatic brain injury are associated with hippocampal atrophy.  Neurology. 2010;  75 (9) 792-798
    CrossrefPubMedGoogle Scholar
  • 16 Tyler K L. Herpes simplex virus infections of the central nervous system: encephalitis and meningitis, including Mollaret's.  Herpes. 2004;  11 (Suppl 2) 57A-64A
    PubMedGoogle Scholar
  • 17 Van de Beek D, de Gans J, Tunkel A R, Wijdicks E F. Community-acquired bacterial meningitis in adults.  N Engl J Med. 2006;  354 (1) 44-53
    CrossrefPubMedGoogle Scholar
  • 18 Carrera E, Claassen J, Oddo M, Emerson R G, Mayer S A, Hirsch L J. Continuous electroencephalographic monitoring in critically ill patients with central nervous system infections.  Arch Neurol. 2008;  65 (12) 1612-1618
    CrossrefPubMedGoogle Scholar
  • 19 Bolton C F, Young G B, Zochodne D W. The neurological complications of sepsis.  Ann Neurol. 1993;  33 (1) 94-100
    CrossrefPubMedGoogle Scholar
  • 20 Gultekin S H, Rosenfeld M R, Voltz R, Eichen J, Posner J B, Dalmau J. Paraneoplastic limbic encephalitis: neurological symptoms, immunological findings and tumour association in 50 patients.  Brain. 2000;  123 (Pt 7) 1481-1494
    CrossrefPubMedGoogle Scholar
  • 21 Lawn N D, Westmoreland B F, Kiely M J, Lennon V A, Vernino S. Clinical, magnetic resonance imaging, and electroencephalographic findings in paraneoplastic limbic encephalitis.  Mayo Clin Proc. 2003;  78 (11) 1363-1368
    CrossrefPubMedGoogle Scholar
  • 22 Dalmau J, Gleichman A J, Hughes E G et al.. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies.  Lancet Neurol. 2008;  7 (12) 1091-1098
    CrossrefPubMedGoogle Scholar
  • 23 McKnight K, Jiang Y, Hart Y et al.. Serum antibodies in epilepsy and seizure-associated disorders.  Neurology. 2005;  65 (11) 1730-1736
    CrossrefPubMedGoogle Scholar
  • 24 Vernino S, Geschwind M, Boeve B. Autoimmune encephalopathies.  Neurologist. 2007;  13 (3) 140-147
    CrossrefPubMedGoogle Scholar
  • 25 Servillo G, Bifulco F, De Robertis E et al.. Posterior reversible encephalopathy syndrome in intensive care medicine.  Intensive Care Med. 2007;  33 (2) 230-236
    CrossrefPubMedGoogle Scholar
  • 26 Niedermeyer E, Freund G, Krumholz A. Subacute encephalopathy with seizures in alcoholics: a clinical-electroencephalographic study.  Clin Electroencephalogr. 1981;  12 (3) 113-129
    PubMedGoogle Scholar
  • 27 Treiman D M, DeGiorgio C, Salisbury S, Wickboldt C. Subtle generalized convulsive status epilepticus.  Epilepsia. 1984;  25 653
    PubMedGoogle Scholar
  • 28 Meador K J, Moser E. Negative seizures.  J Int Neuropsychol Soc. 2000;  6 (6) 731-733
    CrossrefPubMedGoogle Scholar
  • 29 DeLorenzo R J, Kirmani B, Deshpande L S et al.. Comparisons of the mortality and clinical presentations of status epilepticus in private practice community and university hospital settings in Richmond, Virginia.  Seizure. 2009;  18 (6) 405-411
    CrossrefPubMedGoogle Scholar
  • 30 Litt B, Wityk R J, Hertz S H et al.. Nonconvulsive status epilepticus in the critically ill elderly.  Epilepsia. 1998;  39 (11) 1194-1202
    CrossrefPubMedGoogle Scholar
  • 31 Niedermeyer E, Khalifeh R. Petit mal status (“spike-wave stupor”). An electro-clinical appraisal.  Epilepsia. 1965;  6 (3) 250-262
    CrossrefPubMedGoogle Scholar
  • 32 Andermann F, Robb J P. Absence status. A reappraisal following review of thirty-eight patients.  Epilepsia. 1972;  13 (1) 177-187
    CrossrefPubMedGoogle Scholar
  • 33 Thomas P, Beaumanoir A, Genton P, Dolisi C, Chatel M. “De novo” absence status of late onset: report of 11 cases.  Neurology. 1992;  42 (1) 104-110
    CrossrefPubMedGoogle Scholar
  • 34 Agathonikou A, Panayiotopoulos C P, Giannakodimos S, Koutroumanidis M. Typical absence status in adults: diagnostic and syndromic considerations.  Epilepsia. 1998;  39 (12) 1265-1276
    CrossrefPubMedGoogle Scholar
  • 35 Ballenger III C E, King D W, Gallagher B B. Partial complex status epilepticus.  Neurology. 1983;  33 (12) 1545-1552
    CrossrefPubMedGoogle Scholar
  • 36 Cockerell O C, Walker M C, Sander J W, Shorvon S D. Complex partial status epilepticus: a recurrent problem.  J Neurol Neurosurg Psychiatry. 1994;  57 (7) 835-837
    CrossrefPubMedGoogle Scholar
  • 37 Treiman D M, Delgado-Escueta A. Complex partial status epilepticus. In: Delgado-Escueta A, Wasterlain C, Treiman D M, eds. Status Epilepticus. New York: Raven Press; 1983: 69-81
    Google Scholar
  • 38 Shneker B F, Fountain N B. Assessment of acute morbidity and mortality in nonconvulsive status epilepticus.  Neurology. 2003;  61 (8) 1066-1073
    CrossrefPubMedGoogle Scholar
  • 39 Drislane F W. Nonconvulsive status epilepticus: Morbidity and consequences. In: Drislane F W, ed. Status Epilepticus: A Clinical Perspective. Totowa, NJ: Humana Press; 2005: 245-264
    CrossrefGoogle Scholar
  • 40 Young G B, Jordan K G, Doig G S. An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality.  Neurology. 1996;  47 (1) 83-89
    CrossrefPubMedGoogle Scholar
  • 41 Pohlmann-Eden B, Hoch D B, Cochius J I, Chiappa K H. Periodic lateralized epileptiform discharges—a critical review.  J Clin Neurophysiol. 1996;  13 (6) 519-530
    PubMedGoogle Scholar
  • 42 Handforth A, Cheng J T, Mandelkern M A, Treiman D M. Markedly increased mesiotemporal lobe metabolism in a case with PLEDs: further evidence that PLEDs are a manifestation of partial status epilepticus.  Epilepsia. 1994;  35 (4) 876-881
    CrossrefPubMedGoogle Scholar
  • 43 Husain A M, Mebust K A, Radtke R A. Generalized periodic epileptiform discharges: etiologies, relationship to status epilepticus, and prognosis.  J Clin Neurophysiol. 1999;  16 (1) 51-58
    CrossrefPubMedGoogle Scholar
  • 44 Yemisci M, Gurer G, Saygi S, Ciger A. Generalised periodic epileptiform discharges: clinical features, neuroradiological evaluation and prognosis in 37 adult patients.  Seizure. 2003;  12 (7) 465-472
    CrossrefPubMedGoogle Scholar
  • 45 Bickford R G, Butt H R. Hepatic coma: the electroencephalographic pattern.  J Clin Invest. 1955;  34 (6) 790-799
    CrossrefPubMedGoogle Scholar
  • 46 Kaya D, Bingol C A. Significance of atypical triphasic waves for diagnosing nonconvulsive status epilepticus.  Epilepsy Behav. 2007;  11 (4) 567-577
    CrossrefPubMedGoogle Scholar

Suzette M LaRocheM.D. 

Assistant Professor of Neurology, Director of Neurophysiology, Emory University School of Medicine

1365 Clifton Road NE, Atlanta, GA 30322

Email: slaroch@emory.org

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