Department of Neurology, Mayo Clinic, Rochester, Minnesota.
Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
JAMA Neurol. 2016 May 1;73(5):585-90. doi: 10.1001/jamaneurol.2016.0006.
The implications of stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs) sometimes found on prolonged electroencephalographic (EEG) recordings are uncertain.
To evaluate the incidence of SIRPIDs and their clinical implications in critically ill patients.
DESIGN, SETTING, AND PARTICIPANTS: A multicenter, international retrospective study was performed from October 1, 2012, through September 30, 2014, of consecutive adult patients hospitalized in intensive care units with alteration of consciousness who underwent EEG recordings at 3 separate centers. Demographic data, including admission diagnosis, age, sex, history of epilepsy, and EEG findings, were noted. Characteristics of SIRPIDs were documented. Data were evaluated for predictors of SIRPIDs and in-hospital mortality. Data analysis was performed from January 16, 2015, to June 15, 2015.
Incidence of SIRPIDs, association of SIRPIDs with mortality and other EEG characteristics, and EEG and clinical predictors of mortality.
A total of 416 patients were studied. The median age of patients was 60 years (interquartile range, 46-71 years), and 252 (60.6%) were male. A total of 104 patients (25.0%) did not survive to hospital discharge. SIRPIDs were identified in 43 patients (10.3%). The proportion of patients with SIRPIDs was not significantly different across the 3 sites (P = .34). Anoxic brain injury (odds ratio [OR], 3.80; 95% CI, 1.73-8.33; P < .001), the use of antiepileptic medications (OR, 3.24; 95% CI, 1.31-8.00; P = .01), electrographic seizures (OR, 2.85; 95% CI, 1.13-7.19; P = .03), generalized periodic discharges with triphasic morphologic features (OR, 3.66; 95% CI, 1.67-8.02; P = .001), and sporadic sharp waves and periodic discharges (OR, 2.59; 95% CI, 1.13-5.92; P = .02) were independently associated with the presence of SIRPIDs. Older age (OR, 1.02; 95% CI, 1.01-1.04; P = .005), anoxic brain injury (OR, 3.49; 95% CI, 1.96-6.21; P ≤ .001), and absence of EEG reactivity (OR, 8.14; 95% CI, 4.20-15.79; P < .001) but not SIRPIDs (OR, 1.73; 95% CI, 0.79-3.78; P = .17) were independently associated with in-hospital mortality.
In critically ill patients undergoing EEG recordings, SIRPIDs occurred in 43 (10.3%) and were associated with other electrographic abnormalities previously reported to indicate poor prognosis. However, SIRPIDs were not independently associated with in-hospital mortality.
在长时间脑电图（EEG）记录中有时会发现刺激诱导的节律性、周期性或癫痫发作性放电（SIRPIDs），但其影响尚不确定。
评估危重病患者中 SIRPIDs 的发生率及其临床意义。
设计、地点和参与者：这是一项多中心、国际回顾性研究，于 2012 年 10 月 1 日至 2014 年 9 月 30 日在 3 个不同中心对意识改变的重症监护病房住院的成年患者进行连续研究。记录了人口统计学数据，包括入院诊断、年龄、性别、癫痫病史和脑电图发现。记录了 SIRPIDs 的特征。评估了 SIRPIDs 与院内死亡率的预测因素。数据分析于 2015 年 1 月 16 日至 2015 年 6 月 15 日进行。
SIRPIDs 的发生率、SIRPIDs 与死亡率和其他 EEG 特征的关系，以及 EEG 和临床预测死亡率的因素。
共纳入 416 例患者。患者的中位年龄为 60 岁（四分位距，46-71 岁），252 例（60.6%）为男性。共有 104 例（25.0%）患者未存活至出院。43 例（10.3%）患者发现 SIRPIDs。SIRPIDs 患者在 3 个地点的比例无显著差异（P = .34）。缺氧性脑损伤（比值比[OR]，3.80；95%置信区间[CI]，1.73-8.33；P < .001）、使用抗癫痫药物（OR，3.24；95% CI，1.31-8.00；P = .01）、电癫痫发作（OR，2.85；95% CI，1.13-7.19；P = .03）、具有三相形态特征的广泛周期性放电（OR，3.66；95% CI，1.67-8.02；P = .001）和散发性尖波和周期性放电（OR，2.59；95% CI，1.13-5.92；P = .02）与 SIRPIDs 的存在独立相关。年龄较大（OR，1.02；95% CI，1.01-1.04；P = .005）、缺氧性脑损伤（OR，3.49；95% CI，1.96-6.21；P ≤ .001）和 EEG 无反应性（OR，8.14；95% CI，4.20-15.79；P < .001）但不是 SIRPIDs（OR，1.73；95% CI，0.79-3.78；P = .17）与院内死亡率独立相关。
在接受 EEG 记录的危重病患者中，SIRPIDs 的发生率为 43 例（10.3%），与先前报道的表明预后不良的其他电异常相关。然而，SIRPIDs 与院内死亡率无独立相关性。
