Department of Neurology, University of Washington in St. Louis, 660 S. Euclid Avenue, St. Louis, MO 63110, USA.
Neurocrit Care. 2012 Aug;17(1):39-44. doi: 10.1007/s12028-012-9728-7.
Periodic epileptiform discharges (PEDs) are a frequent finding in comatose patients undergoing continuous EEG (cEEG) monitoring, but their clinical significance is unclear. PET and SPECT studies indicate that PEDs can be associated with focal hypermetabolism and hyperemia, suggesting that in some cases this pattern may be ictal and potentially harmful. We hypothesized that frequent PED activity in comatose patients is associated with reduced likelihood of recovery of consciousness.
We identified all comatose patients treated in the Columbia neuro-ICU between June 2008 and August 2009 who underwent ten or more consecutive days of video cEEG monitoring (N = 67), and classified them into three groups: those with (1) prolonged PEDs (five or more consecutive days), (2) intermittent PEDs (at least one but fewer than five consecutive days), and (3) no PEDs. Outcome at discharge was assessed by the Glasgow Outcome Scale and classified as dead (GOS 1), vegetative (GOS 2), and command-following (GOS 3-5).
Mean age was 56 years, mean admission Glasgow Coma Scale score was seven, and the median duration of cEEG monitoring was 18 (range 10-111) days. The most common diagnoses were hypoxic-ischemic encephalopathy (18%), subarachnoid hemorrhage (16%), epilepsy (15%), encephalitis (15%), metabolic encephalopathy (13%), and intracerebral hemorrhage (12%). 37% of patients (N = 25) had prolonged PEDs, 31% (N = 21) had intermittent PEDs, and 31% (N = 21) had no PEDs. Prolonged PEDs were associated with the presence of SIRPIDS (P = 0.009), electrographic seizures (P = 0.019), and number of AEDs administered (P < 0.0001). However, the presence of intermittent or prolonged PED activity had no impact on mortality (31% overall) or recovery of consciousness (command-following) at the time of discharge (36% overall).
Persistent spontaneous PED activity in comatose patients is associated with SIRPIDs and electrographic seizures, but has no impact on the likelihood of survival or recovery of consciousness.
在接受连续 EEG（cEEG）监测的昏迷患者中，周期性癫痫样放电（PED）是一种常见的发现，但它们的临床意义尚不清楚。PET 和 SPECT 研究表明，PED 可与局灶性高代谢和高灌注相关，表明在某些情况下，这种模式可能是发作性的，具有潜在的危害性。我们假设昏迷患者中频繁出现 PED 活动与意识恢复的可能性降低有关。
我们确定了 2008 年 6 月至 2009 年 8 月期间在哥伦比亚神经重症监护病房接受治疗且接受了 10 天或以上连续视频 cEEG 监测的所有昏迷患者（N=67），并将他们分为三组：（1）持续性 PED（连续 5 天或以上），（2）间歇性 PED（至少一次但少于 5 天），和（3）无 PED。出院时的预后通过格拉斯哥预后量表（Glasgow Outcome Scale）进行评估，并分为死亡（GOS 1）、植物状态（GOS 2）和听从命令（GOS 3-5）。
平均年龄为 56 岁，入院时格拉斯哥昏迷量表评分平均为 7 分，cEEG 监测的中位数时间为 18 天（范围 10-111 天）。最常见的诊断为缺氧缺血性脑病（18%）、蛛网膜下腔出血（16%）、癫痫（15%）、脑炎（15%）、代谢性脑病（13%）和脑出血（12%）。37%的患者（N=25）有持续性 PED，31%的患者（N=21）有间歇性 PED，31%的患者（N=21）无 PED。持续性 PED 与 SIRPIDs（P=0.009）、电发作（P=0.019）和使用的 AED 数量（P<0.0001）有关。然而，间歇性或持续性 PED 活动的存在对死亡率（总体 31%）或出院时的意识恢复（总体 36%）没有影响。
昏迷患者持续自发的 PED 活动与 SIRPIDs 和电发作有关，但对生存或意识恢复的可能性没有影响。
