意义不明的三相波脑电图模式患者对抗惊厥试验的反应率
Response Rates to Anticonvulsant Trials in Patients with Triphasic-Wave EEG Patterns of Uncertain Significance.
作者信息
O'Rourke Deirdre, Chen Patrick M, Gaspard Nicolas, Foreman Brandon, McClain Lauren, Karakis Ioannis, Mahulikar Advait, Westover M Brandon
机构信息
Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, WACC 735, Boston, MA, 02114, USA.
Hôpital Erasme - ULB, Cliniques universitaires de Bruxelles, Brussels, Belgium.
出版信息
Neurocrit Care. 2016 Apr;24(2):233-9. doi: 10.1007/s12028-015-0151-8.
BACKGROUND
Generalized triphasic waves (TPWs) occur in both metabolic encephalopathies and non-convulsive status epilepticus (NCSE). Empiric trials of benzodiazepines (BZDs) or non-sedating AED (NSAEDs) are commonly used to differentiate the two, but the utility of such trials is debated. The goal of this study was to assess response rates of such trials and investigate whether metabolic profile differences affect the likelihood of a response.
METHODS
Three institutions within the Critical Care EEG Monitoring Research Consortium retrospectively identified patients with unexplained encephalopathy and TPWs who had undergone a trial of BZD and/or NSAEDs to differentiate between ictal and non-ictal patterns. We assessed responder rates and compared metabolic profiles of responders and non-responders. Response was defined as resolution of the EEG pattern and either unequivocal improvement in encephalopathy or appearance of previously absent normal EEG patterns, and further categorized as immediate (within <2 h of trial initiation) or delayed (>2 h from trial initiation).
RESULTS
We identified 64 patients with TPWs who had an empiric trial of BZD and/or NSAED. Most patients (71.9%) were admitted with metabolic derangements and/or infection. Positive clinical responses occurred in 10/53 (18.9%) treated with BZDs. Responses to NSAEDs occurred in 19/45 (42.2%), being immediate in 6.7%, delayed but definite in 20.0%, and delayed but equivocal in 15.6%. Overall, 22/64 (34.4%) showed a definite response to either BZDs or NSAEDs, and 7/64 (10.9%) showed a possible response. Metabolic differences of responders versus non-responders were statistically insignificant, except that the 48-h low value of albumin in the BZD responder group was lower than in the non-responder group.
CONCLUSIONS
Similar metabolic profiles in patients with encephalopathy and TPWs between responders and non-responders to anticonvulsants suggest that predicting responders a priori is difficult. The high responder rate suggests that empiric trials of anticonvulsants indeed provide useful clinical information. The more than twofold higher response rate to NSAEDs suggests that this strategy may be preferable to BZDs. Further prospective investigation is warranted.
背景
全身性三相波（TPWs）可见于代谢性脑病和非惊厥性癫痫持续状态（NCSE）。苯二氮䓬类药物（BZDs）或非镇静性抗癫痫药物（NSAEDs）的经验性试验常用于鉴别这两种情况，但此类试验的效用存在争议。本研究的目的是评估此类试验的反应率，并调查代谢谱差异是否会影响反应的可能性。
方法
重症监护脑电图监测研究联盟的三个机构回顾性地确定了患有不明原因脑病和TPWs且接受过BZD和/或NSAEDs试验以区分发作期和非发作期模式的患者。我们评估了反应率，并比较了反应者和无反应者的代谢谱。反应定义为脑电图模式的消失以及脑病明确改善或出现先前未出现的正常脑电图模式，并进一步分为即刻反应（试验开始后<2小时内）或延迟反应（试验开始后>2小时）。
结果
我们确定了64例患有TPWs且接受过BZD和/或NSAEDs经验性试验的患者。大多数患者（71.9%）因代谢紊乱和/或感染入院。接受BZDs治疗的患者中有10/53（18.9%）出现阳性临床反应。接受NSAEDs治疗的患者中有19/45（42.2%）出现反应，其中6.7%为即刻反应，20.0%为延迟但明确的反应，15.6%为延迟但不明确的反应。总体而言，22/64（34.4%）对BZDs或NSAEDs有明确反应，7/64（10.9%）有可能反应。反应者与无反应者的代谢差异无统计学意义，除了BZD反应者组白蛋白的48小时低值低于无反应者组。
结论
抗惊厥药物反应者和无反应者中，脑病和TPWs患者的代谢谱相似，这表明很难预先预测反应者。高反应率表明抗惊厥药物的经验性试验确实提供了有用的临床信息。对NSAEDs的反应率高出两倍多，这表明该策略可能优于BZDs。有必要进行进一步的前瞻性研究。
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