Neurosciences Unit, UCL Institute of Child Health, London, UK.
Intensive Care Med. 2012 May;38(5):853-62. doi: 10.1007/s00134-012-2529-9. Epub 2012 Apr 11.
Seizures are common in comatose children, but may be clinically subtle or only manifest on continuous electroencephalographic monitoring (cEEG); any association with outcome remains uncertain.
cEEG (one to three channels) was performed for a median 42 h (range 2-630 h) in 204 unventilated and ventilated children aged ≤15 years (18 neonates, 61 infants) in coma with different aetiologies. Outcome at 1 month was independently determined and dichotomized for survivors into favourable (normal or moderate neurological handicap) and unfavourable (severe handicap or vegetative state).
Of the 204 patients, 110 had clinical seizures (CS) before cEEG commenced. During cEEG, 74 patients (36%, 95% confidence interval, 95% CI, 32-41%) had electroencephalographic seizures (ES), the majority without clinical accompaniment (non-convulsive seizures, NCS). CS occurred before NCS in 69 of the 204 patients; 5 ventilated with NCS had no CS observed. Death (93/204; 46%) was independently predicted by admission Paediatric Index of Mortality (PIM; adjusted odds ratio, aOR, 1.027, 95% CI 1.012-1.042; p < 0.0005), Adelaide coma score (aOR 0.813, 95% CI 0.700-0.943; p = 0.006), and EEG grade on admission (excess slow with >3% fast, aOR 5.43, 95% CI 1.90-15.6; excess slow with <3% fast, aOR 8.71, 95% CI 2.58-29.4; low amplitude, 10th centile <9 µV, aOR 3.78, 95% CI 1.23-11.7; and burst suppression, aOR 10.68, 95% CI 2.31-49.4) compared with normal cEEG, as well as absence of CS at any time (aOR 2.38, 95% CI 1.18-4.81). Unfavourable outcome (29/111 survivors; 26%) was independently predicted by the presence of ES (aOR 15.4, 95% CI 4.7-49.7) and PIM (aOR 1.036, 95% CI 1.013-1.059).
Seizures are common in comatose children, and are associated with an unfavourable outcome in survivors. cEEG allows the detection of subtle CS and NCS and is a prognostic tool.
昏迷患儿常发生癫痫发作，但可能临床症状不明显，或仅在连续脑电图监测（cEEG）中表现出来；任何与结局相关的因素仍不确定。
对 204 名年龄≤15 岁（18 名新生儿，61 名婴儿）无通气和通气的昏迷患儿进行中位数为 42 小时（范围 2-630 小时）的单通道至三通道 cEEG。1 个月时的结局由独立人员确定，并对幸存者进行分类，分为预后良好（正常或中度神经功能障碍）和预后不良（严重残疾或植物状态）。
在 204 名患者中，110 名在 cEEG 开始前有临床癫痫发作（CS）。在 cEEG 期间，74 名患者（36%，95%置信区间，95%CI，32-41%）出现脑电图癫痫发作（ES），其中大多数无临床伴随症状（非惊厥性癫痫发作，NCS）。在 204 名患者中，有 69 名患者 CS 发生在 NCS 之前；5 名接受 NCS 通气的患者未观察到 CS。死亡（204/204；46%）与入院儿科死亡率指数（PIM；调整后的优势比，aOR，1.027，95%CI 1.012-1.042；p < 0.0005）、阿德莱德昏迷评分（aOR 0.813，95%CI 0.700-0.943；p = 0.006）和入院时脑电图分级（存在>3%快波的过度慢波，aOR 5.43，95%CI 1.90-15.6；存在<3%快波的过度慢波，aOR 8.71，95%CI 2.58-29.4；低幅度，第 10 百分位数<9µV，aOR 3.78，95%CI 1.23-11.7；和爆发抑制，aOR 10.68，95%CI 2.31-49.4）有关，而与正常 cEEG 相比，任何时候都不存在 CS（aOR 2.38，95%CI 1.18-4.81）也与预后不良有关。预后不良（111 名幸存者中的 29 名；26%）与 ES 存在（aOR 15.4，95%CI 4.7-49.7）和 PIM（aOR 1.036，95%CI 1.013-1.059）有关。
昏迷患儿常发生癫痫发作，且与幸存者预后不良有关。cEEG 可检测到隐匿性 CS 和 NCS，是一种预后工具。
