St. Luke's University Health Center, Bethlehem, PA.
Yale School of Medicine, New Haven, CT.
Epileptic Disord. 2014 Dec;16(4):439-48. doi: 10.1684/epd.2014.0715.
To determine whether there is added benefit in detecting electrographic abnormalities from 16-24 hours of continuous video-EEG in adult medical/surgical ICU patients, compared to a 30-minute EEG.
This was a prospectively enroled non-randomized study of 130 consecutive ICU patients for whom EEG was requested. For 117 patients, a 30-minute EEG was requested for altered mental state and/or suspected seizures; 83 patients continued with continuous video-EEG for 16-24 hours and 34 patients had only the 30-minute EEG. For 13 patients with prior seizures, continuous video-EEG was requested and was carried out for 16-24 hours. We gathered EEG data prospectively, and reviewed the medical records retrospectively to assess the impact of continuous video-EEG.
A total of 83 continuous video-EEG recordings were performed for 16-24 hours beyond 30 minutes of routine EEG. All were slow, and 34% showed epileptiform findings in the first 30 minutes, including 2% with seizures. Over 16-24 hours, 14% developed new or additional epileptiform abnormalities, including 6% with seizures. In 8%, treatment was changed based on continuous video-EEG. Among the 34 EEGs limited to 30 minutes, almost all were slow and 18% showed epileptiform activity, including 3% with seizures. Among the 13 patients with known seizures, continuous video-EEG was slow in all and 69% had epileptiform abnormalities in the first 30 minutes, including 31% with seizures. An additional 8% developed epileptiform abnormalities over 16-24 hours. In 46%, treatment was changed based on continuous video-EEG.
This study indicates that if continuous video-EEG is not available, a 30-minute EEG in the ICU has a substantial diagnostic yield and will lead to the detection of the majority of epileptiform abnormalities. In a small percentage of patients, continuous video-EEG will lead to the detection of additional epileptiform abnormalities. In a sub-population, with a history of seizures prior to the initiation of EEG recording, the benefits of continuous video-EEG in monitoring seizure activity and influencing treatment may be greater.
与 30 分钟脑电图相比，确定在成人医学/外科 ICU 患者中，检测 16-24 小时连续视频脑电图的电描记图异常是否有额外益处。
这是一项前瞻性纳入的非随机研究，共纳入 130 例连续 ICU 患者，这些患者均被要求进行脑电图检查。117 例患者因精神状态改变和/或疑似癫痫发作而要求进行 30 分钟脑电图检查；83 例患者继续进行 16-24 小时连续视频脑电图检查，34 例患者仅进行 30 分钟脑电图检查。对于 13 例有既往癫痫发作的患者，要求进行连续视频脑电图检查，并进行 16-24 小时检查。我们前瞻性地收集脑电图数据，并回顾性地审查病历，以评估连续视频脑电图的影响。
总共进行了 83 例 16-24 小时的连续视频脑电图检查，超过了 30 分钟的常规脑电图检查。所有脑电图均显示为慢波，34%的脑电图在最初的 30 分钟内显示出癫痫样发现，包括 2%的患者有癫痫发作。在 16-24 小时期间，14%的患者出现新的或额外的癫痫样异常，包括 6%的患者有癫痫发作。在 8%的患者中，治疗方案根据连续视频脑电图检查进行了改变。在 34 例仅进行 30 分钟的脑电图检查中，几乎所有脑电图均显示为慢波，18%的脑电图显示出癫痫样活动，包括 3%的患者有癫痫发作。在 13 例已知癫痫发作的患者中，所有患者的连续视频脑电图均显示为慢波，69%的患者在最初的 30 分钟内出现癫痫样异常，包括 31%的患者有癫痫发作。在 16-24 小时期间，另外 8%的患者出现癫痫样异常。在 46%的患者中，治疗方案根据连续视频脑电图检查进行了改变。
本研究表明，如果无法进行连续视频脑电图检查，在 ICU 中进行 30 分钟脑电图检查具有很高的诊断收益，并且将检测到大多数癫痫样异常。在一小部分患者中，连续视频脑电图将检测到额外的癫痫样异常。在亚人群中，在开始记录脑电图之前有癫痫发作史的患者，连续视频脑电图在监测癫痫发作活动和影响治疗方面的益处可能更大。
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