Muraja-Murro Anu, Mervaala Esa, Westeren-Punnonen Susanna, Lepola Pasi, Töyräs Juha, Myllymaa Sami, Julkunen Petro, Kantanen Anne-Mari, Kälviäinen Reetta, Myllymaa Katja
Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland; School of Medicine, University of Eastern Finland, Kuopio, Finland.
Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland; School of Medicine, University of Eastern Finland, Kuopio, Finland.
Epilepsy Behav. 2015 Aug;49:245-9. doi: 10.1016/j.yebeh.2015.04.041. Epub 2015 May 18.
Acute EEG is vastly underutilized in acute neurological settings. The most common reason for this is simply the fact that acute EEG is not available when needed or getting EEG is delayed as it requires trained technicians and equipment to be properly recorded. We have recently described a handy disposable forehead EEG electrode set that is suitable for acute emergency EEG recordings. The specific objective in this study was to assess the forehead electrode's utility when the clinical demand was to exclude SE.
One hundred consecutive acute neurological patients (53 women, 47 men, age: 18-90 years) with unexplained altered mental state were studied with acute emergency EEG to rule out SE. Electroencephalographic recordings were obtained simultaneously with forehead EEG electrode and routine 10-20 system full-head scalp electrodes to clarify the clinical usefulness of forehead EEG electrode in this setting. Electroencephalographic recordings were interpreted blindly by three experienced clinical neurophysiologists first only based on forehead EEG and then by full-head EEG.
Ninety-six out of the 100 patients did not show EEG evidence of SE. There was 100% agreement with forehead and routine EEG. Four out of the 100 patients showed EEG evidence of SE in routine EEG, with 50% agreement between different electrode types. The forehead EEG missed two cases because the EEG findings supporting SE were restricted to the posterior parts of the brain.
With a forehead EEG set, the sensitivity of detecting NCSE was 50%. There were no false positive cases yielding a specificity of 100%. Patients with AMS can benefit from forehead EEG recording in prehospital, hospital, and ICU settings. Since EEG recording can be started within a few minutes with the forehead EEG set, it will significantly reduce the delay in treatment of SE. This article is part of a Special Issue entitled "Status Epilepticus".
急性脑电图在急性神经科环境中的应用严重不足。最常见的原因仅仅是在需要时无法进行急性脑电图检查，或者由于需要训练有素的技术人员和设备才能正确记录而导致脑电图检查延迟。我们最近描述了一种方便的一次性前额脑电图电极套装，适用于急性紧急脑电图记录。本研究的具体目的是评估在前瞻性排除癫痫持续状态（SE）的临床需求下前额电极的效用。
对100例连续的急性神经科患者（53例女性，47例男性，年龄18 - 90岁）进行研究，这些患者均有不明原因的精神状态改变，通过急性紧急脑电图检查以排除SE。同时使用前额脑电图电极和常规的10 - 20系统全头头皮电极进行脑电图记录，以阐明前额脑电图电极在此情况下的临床实用性。由三位经验丰富的临床神经生理学家首先仅根据前额脑电图进行盲法解读，然后再根据全头脑电图进行解读。
100例患者中有96例未显示脑电图SE证据。前额脑电图和常规脑电图的一致性为100%。100例患者中有4例在常规脑电图中显示脑电图SE证据，不同电极类型之间的一致性为50%。前额脑电图漏诊了2例，因为支持SE的脑电图表现局限于脑后部。
使用前额脑电图套装，检测非惊厥性癫痫持续状态（NCSE）的敏感性为50%。无假阳性病例，特异性为100%。急性意识障碍（AMS）患者在院前、医院和重症监护病房（ICU）环境中均可从前额脑电图记录中获益。由于使用前额脑电图套装可在几分钟内开始脑电图记录，这将显著减少SE治疗的延迟。本文是名为“癫痫持续状态”的特刊的一部分。
