The Impact of Nonconvulsive Status Epilepticus after Cardiac Surgery on Outcome (original) (raw)
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BMC Neurology
Background Extracorporeal circulation (ECC) is now being increasingly used in critical care settings. Epileptic seizures are a recognized but under reported complication in patients receiving this care. Acute symptomatic post-operative seizures have been described, as well as remote seizure, mostly in the form of convulsive seizures. Epilepsy has also been reported, although with lower frequency and mainly with convulsive seizures, while different seizure semiology is rarely described. Case presentation We report a case series of four patients developing epilepsy with homogeneous features following heart surgery with ECC. We present neurophysiological and neuroradiological data and we describe the peculiar characteristics of epilepsies in terms of seizure semiology, frequency, and drug response. The main features are: an insulo-temporal or parieto-occipital semiology, often multifocal and without loss of consciousness or motor manifestations, a high frequency of seizures but with lo...
Nonconvulsive status epilepticus following cardiac arrest: overlooked, untreated and misjudged
Journal of Neurology, 2022
Aims Seizures and status epilepticus (SE) are detected in almost a third of the comatose cardiac arrest survivors. As the literature is quite exhaustive regarding SE with motor symptoms in those patients, little is known about nonconvulsive SE (NCSE). Our aim was to compile the evidence from the literature of the frequency and outcome of NCSE in adult patients remaining in coma after resuscitation. Methods The medical search PubMed was screened for most relevant articles reporting the emergence and outcome of NCSE in comatose post-resuscitated adult patients. Results We identified 11 cohort studies (four prospective observational, seven retrospective) including 1092 patients with SE in 29-96% and NCSE reported in 1-20%. EEG evaluation started at a median of 9.5 h (range 7.5-14.8) after cardiac arrest, during sedation and targeted temperature management (TTM). Favorable outcome after NCSE occurred in 24.5%. We found no study reporting EEG to detect or exclude NCSE in patients remaining in coma prior to the initiation of TTM and without sedation withing the first hours after ROSC. Discussion Studies on NCSE after ROSC are scarce and unsystematic, reporting favorable outcome in every fourth patient experiencing NCSE after ROSC. This suggests that NCSE is often overlooked and outcome after NCSE is not always poor. The low data quality does not allow firm conclusions regarding the effects of NCSE on outcome calling for further investigation. In the meantime, clinicians should avoid equating NCSE after ROSC with poor prognosis.
Outcome of epilepsy surgery correlates with sympathetic modulation and neuroimaging of the heart
Journal of the Neurological Sciences, 2003
Temporal lobe epilepsy (TLE) is frequently associated with sympathetic over-activity. Single photon emission computed tomography (SPECT) with 123 iodine-meta-iodobenzylguanidine (MIBG), a norepinephrine analogue, showed reduced tracer uptake in cardiac sympathetic nerve endings, indicating myocardial catecholamine disturbance. We investigated whether outcome of epilepsy surgery correlates with cardiac autonomic function in TLE patients.
Prognostic Value of Electroencephalography in Cardiac Surgery
The Annals of Thoracic Surgery, 1975
One hundred seventeen patients undergoing cardiac operations over a two-year period were studied. Electroencephalograms were recorded prevratively, in the recovery room (up to 12 hours following operation), 24 hours later, and further as required. Operative and anesthesia data were correlated with EEG findings. All patients had normal EEGs preoperatively. This unusual Occurrence may largely reflect the absence of congenital heart disease and the small number of valvular lesions in our patients.
Effects of Seizures on Cardiac Function
Journal of Clinical Neurophysiology, 2010
Various chronic and acute autonomic effects on the heart are seen during epileptic seizures, and some have been implicated in cases of sudden unexpected death in epilepsy (SUDEP). Chronic autonomic dysfunction, either congenital or acquired through seizures or medications, and structural changes of the heart may all predispose patients to SUDEP. Acute autonomic changes during seizures, in particular ictal bradycardia or transient ischemia, may indicate an increased and preventable risk of mortality in patients with epilepsy. However, there is no definite epidemiologic evidence associating any of the chronic or acute cardiac effects of seizures with SUDEP. Cases of SUDEP and near-SUDEP recorded during long-term electroencephalography monitoring offer some insight into the potential mechanisms leading to SUDEP. These cases suggest that autonomic instability ending in cardiorespiratory arrest may be provoked by postictal suppression rather than by ictal activation of the autonomic nervous system. Additional epidemiologic studies on high-risk populations and access to recorded cases of SUDEP may provide more details about the exact sequence of events leading to death and thus guide the development of possible preventive strategies.
PO18-WE-53 Effect of temporal lobe epilepsy surgery on cardiovascular autonomic functions
Journal of the Neurological Sciences, 2009
those which had interictal EEGs without abnormalities (9 patients) or with bilateral abnormalities (21 patients). In addition, video-EEG monitoring made it possible to rectify the diagnosis among 48 other patients. This approach allowed us to start our first experiment in term of epilepsy surgical treatment. Thirty five patients (19 with HS and 16 with mass lesion) have been operated with good outcomes in 28 cases. Non satisfying results were mostly obtained in patients with an association of secondary generalized seizures and interictal EEG abnormalities. Currently we try to improve our protocol while waiting for accessibility of invasive investigations in our country.
2015
Although mortality rate after cardiac surgery has been drastically reduced, neurological complications remain a significant problem. Several etiologic factors have been proposed, including previous unrecognized neurological abnormality, embolic events, hypoxic insult, low cardiac output, systemic inflammatory response, and altered cerebral blood flow (CBF) and metabolism. Cerebral ischemia can occur when cerebral oxygen is insufficient to meet the global or regional cerebral oxygen consumption. Cerebral circulation is normally regulated by several complex mechanisms, such as metabolic stimuli, chemical stimuli, perfusion pressure, and neural stimuli [1].
Neurological Complications in Cardiac Surgery
Complications in Cardiothoracic Surgery
Purpose of Review Perioperative neurological complications have a significant impact on mortality, morbidity, and quality of life in a growing number of high-risk patients undergoing cardiac surgery. In this comprehensive review, we provide an outline of the current literature with regard to stroke, perioperative neurocognitive disorders (delirium and cognitive decline), postoperative visual loss, and peripheral nerve injury in cardiac surgery. Recent Findings Cardiac surgeons, anesthesiologists, and critical care specialists are facing a new population of cardiosurgical patients who are older and sicker than in previous decades. If neurological complications occur during or after cardiac surgery, they may be devastating. We give insights into the etiology, underlying pathophysiologic mechanisms, incidences, and risk factors of these complications. Current international guidelines and preventive strategies are also discussed. Summary Despite technological and surgical progress aimed to reduce neurological injury in the perioperative period, neurological complications remain prevalent in cardiosurgical patients. An increased awareness of this problem will encourage appropriate risk management, frequent neurological assessments, and prompt therapeutic interventions.