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Neurocritical Care

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01-12-2018 | Original Article

Clinical Correlates of Periodic Discharges and Nonconvulsive Seizures in Posterior Reversible Encephalopathy Syndrome (PRES)

Authors: Laure Bastide, Benjamin Legros, Nishi Rampal, Emily J. Gilmore, Lawrence J. Hirsch, Nicolas Gaspard

Published in: Neurocritical Care | Issue 3/2018

Abstract

Importance

The pathophysiological mechanisms of Posterior Reversible Encephalopathy Syndrome (PRES) and related seizures remain poorly understood. The prevalence and clinical significance of nonconvulsive seizures (NCSz) and related epileptiform patterns during continuous electroencephalography monitoring (CEEG) in PRES have not been well described.

Objective

To report the prevalence, characteristics and risk factors for NCSz and related highly epileptiform patterns in patients with PRES, and to determine their relation to imaging abnormalities and outcome.

Design, Setting and Participants

From a prospective CEEG database, we retrospectively identified patients with PRES and reviewed their medical charts. Based on CEEG findings, we designed a retrospective cohort study comparing two groups defined based on the presence or the absence of NCSz and/or periodic discharges (PDs).

Main outcomes and Measures

The prevalence and risk factors for PDs and NCSz, description of EEG and magnetic resonance imaging (MRI) abnormalities and functional outcome as measured by the Glasgow Outcome Scale (GOS) at hospital discharge.

Results

Among 37 eligible patients, 23 (62%) had PDs or NCSz. The presence of NCSz was associated with the presence of PDs (15/22 vs. 1/15; p = 0.0002). NCSz and PDs were usually either lateralized or bilateral independent and predominated in the posterior regions. No clinical features were associated with the occurrence of PDs or NCSz. Cortical restricted diffusion on MRI was more frequent in the PDs/NCSz group (17/23 vs. 1/14; p < 0.001). PDs/NCSz were associated with worse outcome, with 3 deaths vs. 0 in the no PDs/NCSz group and fewer cases with low disability (4 vs. 9 cases with GOS = 5, p < 0.04).

Conclusions and Relevance

Our results reveal a high prevalence of NCSz and PDs in critically ill patients with PRES and an association with restricted diffusion and worse outcome, whether treating or preventing these EEG findings can improve outcome requires further research.

Fugate JE, Rabinstein AA. Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol. 2015;14:914–25. https://doi.org/10.1016/S1474-4422(15)00111-8.CrossRefPubMed

Roth C, Ferbert A. Posterior reversible encephalopathy syndrome: long-term follow-up. J Neurol Neurosurg Psychiatr. 2010;81:773–7. https://doi.org/10.1136/jnnp.2009.189647.CrossRef

Schweitzer AD, Parikh NS, Askin G, Nemade A, Lyo J, Karimi S, Knobel A, Navi BB, Young RJ, Gupta A. Imaging characteristics associated with clinical outcomes in posterior reversible encephalopathy syndrome. Neuroradiology. 2017;59:379–86. https://doi.org/10.1007/s00234-017-1815-1.CrossRefPubMedCentralPubMed

Covarrubias DJ, Luetmer PH, Campeau NG. Posterior reversible encephalopathy syndrome: prognostic utility of quantitative diffusion-weighted MR images. Am J Neuroradiol. 2002;23:1038–48.PubMedPubMedCentral

Kastrup O, Schlamann M, Moenninghoff C, Forsting M, Goericke S. Posterior reversible encephalopathy syndrome: the spectrum of MR imaging patterns. Clin Neuroradiol. 2015;25:161–71. https://doi.org/10.1007/s00062-014-0293-7.CrossRefPubMed

Moon S-N, Jeon SJ, Choi SS, Song CJ, Chung GH, Yu IK, Kim DH. Can clinical and MRI findings predict the prognosis of variant and classical type of posterior reversible encephalopathy syndrome (PRES)? Acta Radiol. 2013;54:1182–90. https://doi.org/10.1177/024185113491252.CrossRefPubMed

Fugate JE, Claassen DO, Cloft HJ, Kallmes DF, Kozak OS, Rabinstein AA. Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. Mayo Clin Proc. 2010;85:427–32. https://doi.org/10.4065/mcp.2009.0590.CrossRefPubMedCentralPubMed

Kozak OS, Wijdicks EFM, Manno EM, Miley JT, Rabinstein AA. Status epilepticus as initial manifestation of posterior reversible encephalopathy syndrome. Neurology. 2007;69:894–7. https://doi.org/10.1212/01.wnl.0000269780.45472.16.CrossRefPubMed

Kastrup O, Gerwig M, Frings M, Diener H-C. Posterior reversible encephalopathy syndrome (PRES): electroencephalographic findings and seizure patterns. J Neurol. 2012;259:1383–9. https://doi.org/10.1007/s00415-011-6362-9.CrossRefPubMed

10.

Sha Z, Moran BP, McKinney AM, Henry TR. Seizure outcomes of posterior reversible encephalopathy syndrome and correlations with electroencephalographic changes. Epilepsy Behav. EB. 2015;48:70–4. https://doi.org/10.1016/j.yebeh.2015.05.027.CrossRef

11.

Datar S, Singh T, Rabinstein AA, Fugate JE, Hocker S. Long-term risk of seizures and epilepsy in patients with posterior reversible encephalopathy syndrome. Epilepsia. 2015;56:564–8. https://doi.org/10.1111/epi.12933.CrossRefPubMed

12.

Kamiya-Matsuoka C, Tummala S. Electrographic patterns in patients with posterior reversible encephalopathy syndrome and seizures. J Neurol Sci. 2017;375:294–8. https://doi.org/10.1016/j.jns.2017.02.017.CrossRefPubMed

13.

Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology. 2004;62:1743–8.CrossRefPubMed

14.

Cordelli DM, Masetti R, Bernardi B, Barcia G, Gentile V, Biagi C, Prete A, Pession A, Franzoni E. Status epilepticus as a main manifestation of posterior reversible encephalopathy syndrome after pediatric hematopoietic stem cell transplantation. Pediatr Blood Cancer. 2012;58:785–90. https://doi.org/10.1002/pbc.23344.CrossRefPubMed

15.

Ferreira FL, Bota DP, Bross A, Mélot C, Vincent J-L. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001;286:1754–8. https://doi.org/10.1001/jama.286.14.1754.CrossRefPubMed

16.

Hirsch LJ, Laroche SM, Gaspard N, Gerard E, Svoronos A, Herman ST, Mani R, Arif H, Jette N, Minazad Y, Kerrigan JF, Vespa P, Hantus S, Claassen J, Young GB, So E, Kaplan PW, Nuwer MR, Fountain NB, Drislane FW. American clinical neurophysiology society’s standardized critical care eeg terminology: 2012 version. J Clin Neurophysiol. 2013;30:1–27. https://doi.org/10.1097/WNP.0b013e3182784729.CrossRefPubMed

17.

Beniczky S, Hirsch LJ, Kaplan PW, Pressler R, Bauer G, Aurlien H, Brøgger JC, Trinka E. Unified EEG terminology and criteria for nonconvulsive status epilepticus. Epilepsia. 2013;54(Suppl 6):28–9. https://doi.org/10.1111/epi.12270.CrossRefPubMed

18.

Bartynski WS, Boardman JF. Distinct Imaging Patterns and Lesion Distribution in Posterior Reversible Encephalopathy Syndrome. Am. J. Neuroradiol. 2007;28:1320–7. https://doi.org/10.3174/ajnr.A0549.CrossRefPubMedPubMedCentral

19.

Legriel S, Schraub O, Azoulay E, Hantson P, Magalhaes E, Coquet I, Bretonniere C, Gilhodes O, Anguel N, Megarbane B, Benayoun L, Schnell D, Plantefeve G, Charpentier J, Argaud L, Mourvillier B, Galbois A, Chalumeau-Lemoine L, Rivoal M, Durand F, Geffroy A, Simon M, Stoclin A, Pallot J-L, Arbelot C, Nyunga M, Lesieur O, Troché G, Bruneel F, Cordoliani Y-S, Bedos J-P, Pico F. Critically III Posterior Reversible Encephalopathy Syndrome Study Group (CYPRESS), Determinants of recovery from severe posterior reversible encephalopathy syndrome. PLoS ONE. 2012;7:e44534. https://doi.org/10.1371/journal.pone.0044534.CrossRefPubMedCentralPubMed

20.

Siebert E, Bohner G, Endres M, Liman TG. Clinical and radiological spectrum of posterior reversible encephalopathy syndrome: does age make a difference?—A retrospective comparison between adult and pediatric patients. PLoS ONE. 2014. https://doi.org/10.1371/journal.pone.0115073.CrossRefPubMedCentralPubMed

21.

Li Y, Gor D, Walicki D, Jenny D, Jones D, Barbour P, Castaldo J. Spectrum and Potential Pathogenesis of Reversible Posterior Leukoencephalopathy Syndrome. J Stroke Cerebrovasc Dis. 2012;21:873–82. https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.05.010.CrossRefPubMed

22.

Cole AJ. Status epilepticus and periictal imaging. Epilepsia. 2004;45:72–7. https://doi.org/10.1111/j.0013-9580.2004.04014.x.CrossRefPubMed

23.

Cianfoni A, Caulo M, Cerase A, Marca GD, Falcone C, Lella GMD, Gaudino S, Edwards J, Colosimo C. Seizure-induced brain lesions: a wide spectrum of variably reversible MRI abnormalities. Eur J Radiol. 2013;82:1964–72. https://doi.org/10.1016/j.ejrad.2013.05.020.CrossRefPubMed

24.

Magnetic resonance imaging changes related to acute seizure activity—UpToDate, (n.d.). https://www-uptodate-com.ezproxy.ulb.ac.be/contents/magnetic-resonance-imaging-changes-related-to-acute-seizure-activity?source=search_result&search=peri%20ictal%20MRI&selectedTitle=9~150. Accessed August 23 2017.

25.

Pande AR, Ando K, Ishikura R, Nagami Y, Takada Y, Wada A, Watanabe Y, Miki Y, Uchino A, Nakao N. Clinicoradiological factors influencing the reversibility of posterior reversible encephalopathy syndrome: a multicenter study. Radiat Med. 2006;24:659–68. https://doi.org/10.1007/s11604-006-0086-2.CrossRefPubMed

26.

Laccheo I, Sonmezturk H, Bhatt AB, Tomycz L, Shi Y, Ringel M, DiCarlo G, Harris D, Barwise J, Abou-Khalil B, Haas KF. Non-convulsive status epilepticus and non-convulsive seizures in neurological ICU patients. Neurocrit Care. 2015;22:202–11. https://doi.org/10.1007/s12028-014-0070-0.CrossRefPubMed

Title: Clinical Correlates of Periodic Discharges and Nonconvulsive Seizures in Posterior Reversible Encephalopathy Syndrome (PRES)
Authors: Laure Bastide
Benjamin Legros
Nishi Rampal
Emily J. Gilmore
Lawrence J. Hirsch
Nicolas Gaspard
Publication date: 01-12-2018
Publisher: Springer US
Published in: Neurocritical Care / Issue 3/2018
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-018-0548-2

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Clinical Correlates of Periodic Discharges and Nonconvulsive Seizures in Posterior Reversible Encephalopathy Syndrome (PRES)

Abstract

Importance

Objective

Design, Setting and Participants

Main outcomes and Measures

Results

Conclusions and Relevance

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Importance

Objective

Design, Setting and Participants

Main outcomes and Measures

Results

Conclusions and Relevance

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