Department of Neurology, University of California, San Francisco, San Francisco General Hospital, CA 94110, USA.
Mayo Clin Proc. 2013 Apr;88(4):326-31. doi: 10.1016/j.mayocp.2012.12.013.
To determine the frequency and clinical predictors of seizures and markers of epileptiform activity in a non-critically ill general inpatient population.
We performed a retrospective cohort study of patients 18 years and older who underwent inpatient electroencephalography (EEG) between January 1, 2005, and December 31, 2010, for an indication of spells or altered mental status. The EEGs and reports were reviewed for ictal activity, interictal epileptiform abnormalities, and nonepileptiform abnormalities. Demographic and clinical data were gathered from the electronic medical record to determine seizure predictors.
Of 2235 patients screened, 1048 met the inclusion criteria, of which 825 (78.7%) had an abnormal EEG finding. Seizures occurred in 78 of 1048 patients (7.4%), and interictal epileptiform discharges were noted in 194 of 1048 patients (18.5%). An intracranial mass and spells as the indication for the EEG were independently associated with the group of patients experiencing seizures in a multivariate logistic regression model (adjusted for age, sex, EEG indication, intracranial mass, stroke, and history of epilepsy). Ninety-seven percent of patients (69 of 71) experienced their first seizure within 24 hours of monitoring, and the presence of seizures was associated with a lower likelihood of being discharged (odds ratio, 0.45; 95% CI, 0.27-0.76).
Seizures occurred at a high frequency in hospitalized patients with spells and altered mental status. The EEG may be an underused investigative tool in the hospital with the potential to identify treatable causes of these common disorders.
确定非危重病住院患者人群中癫痫发作和癫痫样活动标志物的频率和临床预测因素。
我们对 2005 年 1 月 1 日至 2010 年 12 月 31 日期间因发作或意识状态改变而接受住院脑电图（EEG）检查的 18 岁及以上患者进行了回顾性队列研究。对发作期活动、发作间期癫痫样异常和非癫痫样异常的 EEG 和报告进行了回顾。从电子病历中收集人口统计学和临床数据，以确定癫痫发作的预测因素。
在筛选的 2235 名患者中，有 1048 名符合纳入标准，其中 825 名（78.7%）的 EEG 检查结果异常。1048 名患者中有 78 名（7.4%）发生癫痫发作，194 名（18.5%）出现发作间期癫痫样放电。在多变量逻辑回归模型中（调整年龄、性别、EEG 指征、颅内肿块、中风和癫痫病史），颅内肿块和癫痫发作作为 EEG 指征与患者发生癫痫发作的组独立相关。97%的患者（71 例中的 69 例）在监测的 24 小时内首次发作，癫痫发作与出院可能性降低相关（比值比，0.45；95%置信区间，0.27-0.76）。
在有发作和意识状态改变的住院患者中，癫痫发作的发生率很高。脑电图可能是医院中一种未充分利用的检查工具，有可能发现这些常见疾病的可治疗病因。
