Praline Julien, Grujic Jéléna, Corcia Philippe, Lucas Brigitte, Hommet Caroline, Autret Alain, de Toffol Bertrand
Service de Neurologie et de Neurophysiologie Clinique, Hôpital Bretonneau, CHRU, 2 boulevard Tonnellé, 37044 Tours cedex 9, France.
Clin Neurophysiol. 2007 Oct;118(10):2149-55. doi: 10.1016/j.clinph.2007.07.003. Epub 2007 Aug 20.
Emergency situations require a rapid and precise diagnostic approach. However, the exact role and value of the electroencephalogram (EEG) in emergent conditions have yet to be clearly defined. Our objective was to determine why clinicians order an emergency EEG, to assess to what extent it helps establish a correct diagnosis and to evaluate the result it has on subsequent patient management.
We studied all successive emergency EEGs ordered during a 3-month period in our institution. We analyzed the reasons why each EEG was ordered and interviewed the prescribing clinicians in order to determine the impact the result of the EEG had on the diagnosis and subsequent therapeutic management.
We prospectively studied a total of 111 consecutive recordings. The main reasons for ordering an emergent EEG were: suspected cerebral death (21%), non-convulsive status epilepticus (19.7%), subtle status epilepticus (14%) and follow-up of convulsive status epilepticus (11.2%). In 77.5% of the cases the clinicians considered that the EEG contributed to making the diagnosis and that it helped confirm a clinically-suspected diagnosis in 36% of the cases. When subtle status epilepticus (SSE) or non-convulsive status epilepticus (NCSE) was suspected, the diagnosis was confirmed in 45% and 43.3% of the cases, respectively. In 22.2% of the requests involving follow-up of convulsive status epilepticus after initial treatment, the EEG demonstrated persistent status epilepticus. It resulted in a change in patient treatment in 37.8% of all the cases. When the EEG helped establish the diagnosis, patient treatment was subsequently modified in 46.6% of the cases.
This prospective study confirms the value of an emergent EEG in certain specific clinical contexts: the management of convulsive status epilepticus following initial treatment or to rule out subtle status epilepticus. An emergent EEG can also be ordered if one suspects the existence of non-convulsive status epilepticus when a patient presents with mental confusion or altered wakefulness after first looking for the specific signs suggesting this diagnostic hypothesis.
After 50 years of development and use in daily practice, the EEG remains a dependable, inexpensive and useful diagnostic tool in a number of clearly-defined emergency situations.
紧急情况需要快速且精确的诊断方法。然而，脑电图（EEG）在紧急情况下的确切作用和价值尚未明确界定。我们的目的是确定临床医生开具紧急脑电图检查的原因，评估其在多大程度上有助于确立正确诊断，并评估其对后续患者管理的影响。
我们研究了本机构在3个月期间内连续开具的所有紧急脑电图检查。我们分析了每项脑电图检查开具的原因，并采访了开单的临床医生，以确定脑电图检查结果对诊断和后续治疗管理的影响。
我们前瞻性地研究了总共111次连续记录。开具紧急脑电图检查的主要原因是：疑似脑死亡（21%）、非惊厥性癫痫持续状态（19.7%）、隐匿性癫痫持续状态（14%）以及惊厥性癫痫持续状态的随访（11.2%）。在77.5%的病例中，临床医生认为脑电图有助于做出诊断，且在36%的病例中有助于证实临床怀疑的诊断。当怀疑隐匿性癫痫持续状态（SSE）或非惊厥性癫痫持续状态（NCSE）时，分别在45%和43.3%的病例中确诊。在22.2%涉及初始治疗后惊厥性癫痫持续状态随访的申请中，脑电图显示癫痫持续状态仍存在。在所有病例中，有37.8%导致了患者治疗的改变。当脑电图有助于确立诊断时，随后在46.6%的病例中对患者治疗进行了调整。
这项前瞻性研究证实了紧急脑电图检查在某些特定临床情况下的价值：初始治疗后惊厥性癫痫持续状态的管理或排除隐匿性癫痫持续状态。如果在寻找提示该诊断假设的特定体征后，患者出现精神错乱或意识改变，怀疑存在非惊厥性癫痫持续状态时，也可开具紧急脑电图检查。
在日常实践中经过50年的发展和应用，脑电图在一些明确界定的紧急情况下仍然是一种可靠、廉价且有用的诊断工具。
