Abstract
Objective: To evaluate the impact of nonconvulsive seizures (NCS) and nonconvulsive status epilepticus (NCSE) diagnosed via continuous electroencephalogram (cEEG) monitoring on short-term neurological outcomes and disability in patients with moderate to severe traumatic brain injury (TBI).
Design: A prospective observational study.
Setting: A tertiary care intensive care unit (ICU) specializing in neurological and trauma care.
Patients and participants: A total of 44 patients aged >18 years with moderate to severe TBI, classified using the Glasgow Coma Scale (GCS), were included. Patients with a history of seizures, anoxic brain injury, or brainstem death were excluded.
Interventions: Continuous EEG monitoring was performed using the Salzburg Consensus Criteria to detect and classify NCSE and NCS. Patients were categorized into NCSE, possible NCSE, and no NCSE groups based on cEEG findings.
Measurements and results: Outcome measures included neurological deterioration on day 7, Glasgow Outcome Score Extended (GOS-E) at 28 days, and duration of hospital stay. Patients with NCSE exhibited significantly worse outcomes, including lower GCS scores (p<0.05), higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (p<0.001), and prolonged hospital stays (p<0.001). Neurological deterioration was observed in 100% of NCSE patients compared to 20% in possible NCSE and 0% in no NCSE groups (p<0.001). Intracranial hemorrhage on follow-up imaging was more frequent in the NCSE group (47.1%, p=0.027).
Conclusions: NCSE diagnosed by cEEG monitoring in moderate to severe TBI is associated with the poorest short-term outcomes, including higher rates of disability, prolonged hospitalization, and increased neurological deterioration. Early implementation of cEEG monitoring is critical for timely diagnosis and management in this high-risk population.
Mohamed Ibrahim Afifiy, Hanan Elsayed Zaghla, Mohamed Abd Elmnem Abo Elghat, Saly Hasan Elkholy, Amr Abdelhamid Karam
