Yanagino Yusuke, Yamasumi Taro, Miyauchi Takayuki, Inoue Koichi, Kondoh Haruhiko
Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety, Osaka Rosai Hospital, Sakai, Osaka, 591-8025, Japan.
Gen Thorac Cardiovasc Surg Cases. 2025 Jan 24;4(1):5. doi: 10.1186/s44215-025-00189-3.
Epileptic seizures following adult cardiovascular surgery occur in 0.9-3% of patients, with the condition in 3-12% of these patients progressing to status epilepticus (SE). SE is a severe condition that significantly impacts prognosis and necessitates early diagnosis and treatment. However, the diagnosis of nonconvulsive status epilepticus (NCSE) is challenging due to its subtle clinical symptoms. Herein, we report a case of NCSE that was diagnosed early by aggressive electroencephalogram (EEG) and treated effectively following cardiac surgery, resulting in discharge without sequelae.
A 44-year-old man with a history of meningitis-induced intellectual disability since childhood underwent aortic valve replacement and grafting of the ascending aorta for a bicuspid aortic valve, severe aortic regurgitation, and ascending aortic dilatation. We observed repeated tonic-clonic seizures on the day of surgery and the following day when the sedation was reduced. On the first postoperative day, an EEG revealed sharp, high-amplitude waves during the tonic-clonic seizure and 2-Hz rhythmic delta activity after motor symptoms disappeared. Based on these findings, the patient was diagnosed with NCSE. Under EEG monitoring, we initially used propofol at 4 mg/kg/h, but owing to a decrease in blood pressure, we achieved deep sedation and burst suppression by combining propofol at 1.5 mg/kg/h with midazolam at 0.18 mg/kg/h. We also administered levetiracetam and fosphenytoin as antiseizure medications. Levetiracetam was administered at 1000 mg/day and fosphenytoin at 20.5 mg/kg, followed by maintenance at 7.2 mg/kg/day. The patient's consciousness improved upon cessation of sedation on postoperative day 6. Postoperative magnetic resonance imaging revealed no abnormalities. Fosphenytoin was discontinued, and the patient was discharged on postoperative day 32 without any sequelae. The patient continues to take levetiracetam orally at a dose of 1000 mg/day and has been followed up in the outpatient clinic for 4 years without any seizure recurrence.
Postoperative seizures following cardiac surgery may occur with NCSE, even after visible seizures have ceased. This case highlights the importance of thorough EEG monitoring in cases of prolonged disturbance of consciousness, indicating that early diagnosis and treatment of NCSE can improve the prognosis.
成人心血管手术后癫痫发作发生率为0.9% - 3%，其中3% - 12%的患者病情进展为癫痫持续状态（SE）。SE是一种严重疾病，对预后有显著影响，需要早期诊断和治疗。然而，非惊厥性癫痫持续状态（NCSE）因其临床症状不明显，诊断具有挑战性。在此，我们报告一例NCSE病例，该病例通过积极的脑电图（EEG）检查得以早期诊断，并在心脏手术后得到有效治疗，出院时无后遗症。
一名44岁男性，自幼因脑膜炎导致智力残疾，因二叶式主动脉瓣、严重主动脉瓣反流和升主动脉扩张接受主动脉瓣置换及升主动脉移植术。在手术当天及术后次日镇静剂减量时，我们观察到患者反复出现强直 - 阵挛性发作。术后第一天，EEG显示强直 - 阵挛性发作时出现尖锐、高幅波，运动症状消失后出现2赫兹节律性δ活动。基于这些发现，患者被诊断为NCSE。在EEG监测下，我们最初以4毫克/千克/小时的速度使用丙泊酚，但由于血压下降，我们将丙泊酚以1.5毫克/千克/小时与咪达唑仑以0.18毫克/千克/小时联合使用，实现了深度镇静和爆发抑制。我们还给予左乙拉西坦和磷苯妥英作为抗癫痫药物。左乙拉西坦的给药剂量为1000毫克/天，磷苯妥英为20.5毫克/千克，随后维持剂量为7.2毫克/千克/天。术后第6天停止镇静后，患者意识有所改善。术后磁共振成像未发现异常。磷苯妥英停药，患者术后第32天出院，无任何后遗症。患者继续口服左乙拉西坦，剂量为1000毫克/天，已在门诊随访4年，无癫痫复发。
心脏手术后即使可见癫痫发作停止，仍可能发生NCSE。该病例强调了在意识长期障碍的情况下进行全面EEG监测的重要性，表明NCSE的早期诊断和治疗可改善预后。
