Mohammad Anadani, MD

Matsubara S, Sato S, Kodama T, Egawa S, Nakamoto H, Toyoda K, et al. Nonconvulsive Status Epilepticus in Acute Intracerebral Hemorrhage. Stroke. 2018

Nonconvulsive status epileptics (NCSE) is one of the known complications of intracerebral hemorrhage (ICH). However, the incidence and predictors of NCSE after ICH are not well reported.

In this article, the authors aimed to report the frequency and predictors of NCSE in the nontraumatic ICH and to investigate the effect of NCSE on the functional outcome.

This study was a retrospective, single-center study of patients with nontraumatic ICH who were admitted within three days of symptoms onset. NCSE was defined based on the modified Salzburg Consensus Criteria. Lobar hemorrhage was defined as ICH in the frontal, parietal, temporal, occipital or insular lobe.

The authors included 228 patients of whom 20 (8.8%) developed NCSE during their hospital stay. When compared with patients without NCSE, the NCSE group had a higher ICH score on admission, and lower Glasgow Coma Scale (GCS). Additionally, more patients in the NCSE group were intubated and underwent craniotomy.

In logistic regression models adjusting for ICH score, anticonvulsant use within 24 hours, craniotomy, intraventricular hemorrhage, hydrocephalus, midline shift (>5mm), hematoma volume (per 10 ml) and lobar involvement; only lobar hemorrhage and craniotomy were predictors of NCSE.

Concerning the outcome, patients with NCSE had a worse functional outcome (assessed using Modified Rankin Scale) and a higher mortality rate on discharge. However, NCSE was not associated with a poor functional outcome or mortality after adjusting for ICH score and sex.

The abovementioned study has multiple limitations. First, it was a retrospective single-center study, which limits the generalizability of the findings. Second, only 43% of the included patients underwent electroencephalography (EEG) during their hospital stay; therefore, the incidence of NCSE could be underestimated in this study. Third, only 20 patients had NCSE; consequently, the lack of association between different variables (including hematoma volume, midline shift, hydrocephalus and intraventricular hemorrhage) and NCSE could be related to the small sample size. Similarly, the study could be underpowered to detect an association between NCSE and outcome.

Overall, this study suggests that NCSE is not uncommon after ICH, especially in patients with lobar ICH and patients who underwent craniotomy.

Performing EEG on all ICH patients is the easiest way to detect NCSE; however, this approach is not practical and could result in a significant financial and workload burden. Therefore, future prospective studies are needed to identify patients who could benefit from screening EEG and to investigate the best approach to diagnose and treat NCSE in ICH patients.