Die Anwendung der Salzburg-Kriterien in der Diagnose des non-konvulsiven Status epilepticus

Zusammenfassung

Aufgrund oftmals nur subtiler motorischer Phänomene stellt die Diagnose des nicht-konvulsiven Status epilepticus (non-convulsive status epilepticus, NCSE) eine häufige Differentialdiagnose bei Patientinnen und Patienten mit Vigilanzminderung dar. Da eine frühe adäquate Therapie des NCSE mit einem besseren Therapieansprechen sowie funktionellen Outcome einhergeht, ist eine sichere und frühe diagnostische Sicherung von hoher Relevanz. Aufbauend auf den Ergebnissen des „London-Innsbruck Coloquium on Status Epilepticus and Acute Seizures“, welches 2013 in Salzburg stattfand, wurde von einer Expertengruppe ein Diagnosealgorithmus basierend auf elektroenzephalographischen und klinischen Kriterien entwickelt, der als „Salzburg-Kriterien“ bekannt ist. Über die letzten Jahre wurden diese Kriterien validiert und klinisch erprobt, teilweise aber auch hinsichtlich ihrer Anwendbarkeit kritisiert. Dieser Artikel erläutert die Salzburg-Kriterien und diskutiert potenzielle Fallstricke in der Anwendung.

Abstract

Due to often only subtle motor phenomena, the diagnosis of non-convulsive status epilepticus (NCSE) is a frequent differential diagnosis in patients with impaired vigilance. Since an early adequate therapy of NCSE is related to a better therapy response as well as functional outcome, a precise and early diagnostic verification is of high relevance. Based on the results of the “London-Innsbruck Coloquium on Status Epilepticus and Acute Seizures”, which took place in Salzburg in 2013, a group of experts developed a diagnostic algorithm based on electroencephalographic and clinical criteria, known as the “Salzburg Criteria”. Over the last years, these criteria have been clinically tested and established, but also partly criticized regarding their applicability. This article explains the Salzburg criteria and discusses potential pitfalls in their application.

Schlüsselwörter

Anfall - Epilepsie - Neurologie - Notfallmedizin - Elektroencephalographie

Key words

Seizure - Epilepsy - Neurology - Neurocritical Care - Electroencephalography

• Literatur

• 1 Rosenow F, Weber J. Status epilepticus im Erwachsenenalter. Leitlinien für Diagnostik und Therapie in der Neurologie. 2020 AWMF-Registernummer: 030/079
• 2 Sutter R, Ruegg S, Kaplan PW. Epidemiology, diagnosis, and management of nonconvulsive status epilepticus: Opening Pandora’s box. Neurol Clin Pract 2012; 2: 275-286
• 3 Rüegg S. Nicht-konvulsiver Status epilepticus des Erwachsenen: Typen, Pathophysiologie, Epidemiologie, Ursachen und Diagnose. Aktuel Neurol 2017; 44: 645-611
• 4 Strzelczyk A, Ansorge S, Hapfelmeier J. et al. Costs, length of stay, and mortality of super-refractory status epilepticus: A population-based study from Germany. Epilepsia 2017; 58: 1533-1541
• 5 Willems LM, Hochbaum M, Frey K. et al. Multicenter, cross-sectional study of the costs of illness and cost-driving factors in adult patients with epilepsy. Epilepsia 2022; 63: 904-918
• 6 Frey K, Zollner JP, Knake S. et al. Risk incidence of fractures and injuries: a multicenter video-EEG study of 626 generalized convulsive seizures. J Neurol 2020; 267: 3632-3642
• 7 Lado FA, Moshe SL. How do seizures stop?. Epilepsia 2008; 49: 1651-1664
• 8 Drislane FW. Presentation, evaluation, and treatment of nonconvulsive status epilepticus. Epilepsy Behav 2000; 1: 301-314
• 9 Trinka E, Cock H, Hesdorffer D. et al. A definition and classification of status epilepticus – Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia 2015; 56: 1515-1523
• 10 Sutter R, Kaplan PW. Electroencephalographic criteria for nonconvulsive status epilepticus: synopsis and comprehensive survey. Epilepsia 2012; 53: 1-51
• 11 Young GB, Jordan KG, Doig GS. An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology 1996; 47: 83-89
• 12 Chong DJ, Hirsch LJ. Which EEG patterns warrant treatment in the critically ill? Reviewing the evidence for treatment of periodic epileptiform discharges and related patterns. J Clin Neurophysiol 2005; 22: 79-91
• 13 Kaplan PW. EEG criteria for nonconvulsive status epilepticus. Epilepsia 2007; 48: 39-41
• 14 Leitinger M, Beniczky S, Rohracher A. et al. Salzburg Consensus Criteria for Non-Convulsive Status Epilepticus – approach to clinical application. Epilepsy Behav 2015; 49: 158-163
• 15 Leitinger M, Trinka E. Nonkonvulsiver Status epilepticus – Diagnosekriterien. Z Epiletol 2018; 31: 240-244
• 16 Leitinger M, Trinka E, Gardella E. et al. Diagnostic accuracy of the Salzburg EEG criteria for non-convulsive status epilepticus: a retrospective study. Lancet Neurol 2016; 15: 1054-1062
• 17 Goselink RJM, van Dillen JJ, Aerts M. et al. The difficulty of diagnosing NCSE in clinical practice; external validation of the Salzburg criteria. Epilepsia 2019; 60: e88-e92
• 18 Leitinger M, Trinka E, Zimmermann G. et al. Letter to: Salzburg criteria for noncovulsive status epilepticus: Details matter. Epilepsia 2019; 60: 2334-2336
• 19 Krogstad MH, Hogenhaven H, Beier CP. et al. Nonconvulsive Status Epilepticus: Validating the Salzburg Criteria Against an Expert EEG Examiner. J Clin Neurophysiol 2019; 36: 141-145
• 20 Dominguez AG, Mateo Montero RC, Diaz Cid A. et al. Salzburg Criteria, A Useful Tool in Non-Convulsive Status Epilepticus Diagnosis: A Retrospective Study. Clin EEG Neurosci 2021; 52: 422-426
• 21 Roshdy A, Saleh AS. Salzburg criteria: can we extend valitation to critical care. The Lancet Neurology 2017; 16: 25
• 22 Lee JW. Defining and Validating the Salzburg Criteria: It’s Complicated. Epilepsy Curr 2017; 17: 37-39
• 23 Kienitz R, Kay L, Beuchat I. et al. Benzodiazepines in the Management of Seizures and Status Epilepticus: A Review of Routes of Delivery, Pharmacokinetics, Efficacy, and Tolerability. CNS Drugs 2022; 36: 951-975
• 24 Willems LM, Bauer S, Jahnke K. et al. Therapeutic Options for Patients with Refractory Status Epilepticus in Palliative Settings or with a Limitation of Life-Sustaining Therapies: A Systematic Review. CNS Drugs 2020; 34: 801-826
• 25 Cornwall CD, Dahl SM, Nguyen N. et al. Association of ictal imaging changes in status epilepticus and neurological deterioration. Epilepsia 2022; 63: 2970-2980
• 26 Ohtomo S, Otsubo H, Arai H. et al. Hyperperfusion in the thalamus on arterial spin labelling indicates non-convulsive status epilepticus. Brain Commun 2021; 3: fcaa223
• 27 Giovannini G, Malagoli M, Turchi G. et al. Cortical and thalamic hyper-perfusion in non-convulsive status epilepticus. Relationship between perfusion CT patterns and Salzburg EEG criteria. Seizure 2021; 92: 10-17
• 28 Romoli M, Merli E, Galluzzo S. et al. Hyperperfusion Tmax mapping for nonconvulsive status epilepticus in the acute setting: A pilot case-control study. Epilepsia 2022; 63: 2534-2542
• 29 Hanin A, Demeret S, Nguyen-Michel VH. et al. Continuous EEG monitoring in the follow-up of convulsive status epilepticus patients: A proposal and preliminary validation of an EEG-based seizure build-up score (EaSiBUSSEs). Neurophysiol Clin 2021; 51: 101-110
• 30 Azman F, Tezer FI, Saygi S. Aphasic status epilepticus in a tertiary referral center in Turkey: Clinical features, etiology, and outcome. Epilepsy Res 2020; 167: 106479
• 31 Octaviana F, Bestari AP, Loho AM. et al. Nonconvulsive Status Epilepticus in Metabolic Encephalopathy in Indonesia Referral Hospital. Neurol India 2021; 69: 354-359