Department of Neurology, Division of Pediatric Neurology, Columbia University College of Physician & Surgeons, United States; Department of Pediatrics, Section of Neurology and Developmental Neuroscience, Baylor College of Medicine, United States; Department of Neurology, Kellaway Section of Neurophysiology, Baylor College of Medicine, United States.
Epilepsy Res. 2013 Oct;106(3):378-85. doi: 10.1016/j.eplepsyres.2013.06.019. Epub 2013 Aug 21.
Generalized periodic epileptiform discharges (GPDs) are a specific periodic EEG pattern, reported as having a poor clinical outcome. The incidence and clinical implications of this EEG pattern in children are not known. In this study, we examined the clinical features of children with GPDs.
EEG-video monitoring reports of children with critical illness in the intensive care unit were retrospectively reviewed to detect GPDs. The clinical history, hospital course and seizure characteristics were reviewed and outcome was based on the clinical findings at hospital discharge.
Twenty one children (age 2-18 years) were identified with GPDs. The most common underlying etiology was encephalitis (N=11). At the time of EEG, a continuous intravenous infusion (cIV) of an anticonvulsant drug was used to treat refractory status epilepticus (RSE). Non-convulsive seizures (NCS) were identified in 15, and clinical seizures in 13 children after GPDs were detected. GPDs occurred after a dose reduction in the cIV in 43%. Neuroimaging done in 16 children showed an acute change in 13/16 (81%) and chronic changes in 2/16 (13%). Five children (23%) died. Seven (33%) children had a favorable outcome, whereas the remaining children had a moderate to severe disability at the time of hospital discharge.
GPDs are seen during the course of RSE in critically ill children and are associated with seizure recurrence. A lower mortality rate occurs in children with GPDs compared to adult counterparts, likely related to different etiologies. Although the significance of GPDs must be determined within the context of the clinical situation, GPDs suggest a still active epileptic process.
广义周期性癫痫样放电（GPDs）是一种特定的周期性脑电图模式，据报道其临床预后较差。目前尚不清楚这种脑电图模式在儿童中的发生率和临床意义。在本研究中，我们研究了患有 GPDs 的儿童的临床特征。
回顾性审查重症监护病房中患有危重病的儿童的脑电图-视频监测报告，以检测 GPDs。回顾了临床病史、住院过程和发作特征，出院时的临床发现是根据结果进行评估的。
共发现 21 例（年龄 2-18 岁）儿童存在 GPDs。最常见的潜在病因是脑炎（N=11）。在脑电图检查时，使用持续静脉输注（cIV）抗癫痫药物来治疗难治性癫痫持续状态（RSE）。在 15 例中发现了非惊厥性发作（NCS），在 13 例中发现了临床发作。在 GPDs 发生之前，有 43%的患儿减少了 cIV 的剂量。对 16 例儿童进行神经影像学检查，发现 13/16（81%）例有急性改变，2/16（13%）例有慢性改变。有 5 例儿童（23%）死亡。7 例（33%）儿童预后良好，而其余儿童在出院时存在中重度残疾。
在危重病儿童 RSE 期间会出现 GPDs，且与发作复发相关。与成人相比，患有 GPDs 的儿童死亡率较低，这可能与不同的病因有关。虽然必须在临床情况下确定 GPDs 的意义，但 GPDs 提示仍存在活跃的癫痫发作过程。
