Riassunto analitico
Objective: EEG studies characterizing seizures duration and onset patterns in status epilepticus are lacking. The aim of the study is to characterize different electrographic seizure onset patterns (SOn) and seizures’ duration both in focal status epilepticus and in isolated focal seizures and to compare these variables within these two groups.
Methods: About the test group, consecutive scalp EEG recordings from adult patients admitted for focal status epilepticus from January 2015 to August 2019 were reviewed. About the control group, SOn pattern and duration of isolated focal seizures in patients admitted to the epilepsy monitoring unit between January 2020 and August 2021 were reviewed. SOn patterns were identified according to previous studies. For each patient from both test and control group 1 to 5 seizures were analyzed, and each seizure’s duration was recorded.
Results: 307 focal seizures were analyzed in 100 consecutive SE episodes with a median seizure duration of 90 sec (IQR: 136 sec); 134 isolated focal seizures in 42 patients with epilepsy were recorded with a median duration of 60 sec (IQR: 55 sec)(p < .001). Acute symptomatic etiology significantly increased the seizures’ duration (95%CI 0.123-0.883, p = .01). SOn #3 (repetitive spike and waves) was more frequently observed in SE compared to the epilepsy group (37% vs 10% respectively; p < .001), while SOn #4 (ictal EEG suppression/flattening) shown the opposite being more frequent in the epilepsy group (33% vs 1%; p > .001). Seizures with SOn pattern #3 showed longest duration (maximum duration 1200 seconds) compared to other SOn patterns (p < .05). No difference in demographics, SE etiology, semeiology and treatment response was observed among the different SOn patterns, while patients older than 75 years showing SOn #3 had a significantly high risk for 30 days mortality (HR 4.059; 95% CI 1.508-10.924, p= 0.006).
Significance: focal seizures within a SE episode had a longer median duration and different seizure-onset patterns compared to focal isolated seizures. This was mainly evident for SOn pattern characterized by repetitive epileptiform discharges (spike and waves).
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