Thompson Stephen A, Hantus Stephen
*Department of Neurology, University of Texas Health Science Center, Houston, Texas, U.S.A.; and†Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.
J Clin Neurophysiol. 2016 Feb;33(1):66-71. doi: 10.1097/WNP.0000000000000232.
Pharmacologic sedation is often used to induce burst suppression in cases of refractory status epilepticus, but there is little evidence to guide the weaning of sedation. Similarly, the morphologic feature of bursts is of unknown clinical relevance. Recently, the standardized American Clinical Neurophysiology Society terminology of critical care EEG introduced the term highly epileptiform bursts (HEBs). Knowing the association of HEBs with seizure may direct the therapy for refractory status epilepticus.
Consecutive adult patients classified as having burst suppression were identified in our EEG database. Those of an anoxic etiology were excluded. Available EEG records were reviewed, both visually and quantitatively, for the presence of burst suppression. Using the American Clinical Neurophysiology Society terminology, burst suppression was dichotomized into HEBs or nonepileptiform bursts. Periods of transition out of burst suppression were identified, and whether burst suppression was followed by seizure or a continuous slow EEG within 24 hours was determined.
Twenty-four patients were identified with a burst suppression pattern followed by either seizure or a continuous slow EEG within 24 hours, with some patients having multiple (maximal 5) transitions out of burst suppression, for a total of 33 examples of burst suppression. HEBs were associated with subsequent seizure (P = 0.0001), independent of medication exposure.
Whether or not HEBs are indeed predictive of recurrent seizure or may be used to direct the therapy for status epilepticus, specifically the weaning of anesthetic medications, requires further prospective study in a larger cohort of patients.
在难治性癫痫持续状态的病例中，药物镇静常用于诱导爆发抑制，但几乎没有证据可指导镇静的撤药。同样，爆发的形态学特征的临床相关性尚不清楚。最近，美国临床神经生理学会重症监护脑电图标准化术语引入了高度癫痫样爆发（HEB）这一术语。了解HEB与癫痫发作的关联可能会指导难治性癫痫持续状态的治疗。
在我们的脑电图数据库中识别出连续的成年爆发抑制患者。排除缺氧病因的患者。对可用的脑电图记录进行视觉和定量检查，以确定是否存在爆发抑制。使用美国临床神经生理学会的术语，将爆发抑制分为HEB或非癫痫样爆发。确定从爆发抑制状态转变的时期，并确定爆发抑制后24小时内是否出现癫痫发作或持续的慢脑电图。
确定了24例患者出现爆发抑制模式，随后在24小时内出现癫痫发作或持续的慢脑电图，一些患者有多次（最多5次）从爆发抑制状态转变，共有33例爆发抑制。HEB与随后的癫痫发作相关（P = 0.0001），与药物暴露无关。
HEB是否确实可预测癫痫复发或可用于指导癫痫持续状态的治疗，特别是麻醉药物的撤药，需要在更大的患者队列中进行进一步的前瞻性研究。
