Kim J A, Rosenthal E S, Biswal S, Zafar S, Shenoy A V, O'Connor K L, Bechek S C, Valdery Moura J, Shafi M M, Patel A B, Cash S S, Westover M B
Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA.
Beth Israel Deaconess Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA.
Clin Neurophysiol. 2017 Jun;128(6):1091-1099. doi: 10.1016/j.clinph.2017.01.016. Epub 2017 Jan 29.
To identify whether abnormal neural activity, in the form of epileptiform discharges and rhythmic or periodic activity, which we term here ictal-interictal continuum abnormalities (IICAs), are associated with delayed cerebral ischemia (DCI).
Retrospective analysis of continuous electroencephalography (cEEG) reports and medical records from 124 patients with moderate to severe grade subarachnoid hemorrhage (SAH). We identified daily occurrence of seizures and IICAs. Using survival analysis methods, we estimated the cumulative probability of IICA onset time for patients with and without delayed cerebral ischemia (DCI).
Our data suggest the presence of IICAs indeed increases the risk of developing DCI, especially when they begin several days after the onset of SAH. We found that all IICA types except generalized rhythmic delta activity occur more commonly in patients who develop DCI. In particular, IICAs that begin later in hospitalization correlate with increased risk of DCI.
IICAs represent a new marker for identifying early patients at increased risk for DCI. Moreover, IICAs might contribute mechanistically to DCI and therefore represent a new potential target for intervention to prevent secondary cerebral injury following SAH.
These findings imply that IICAs may be a novel marker for predicting those at higher risk for DCI development.
确定以癫痫样放电以及节律性或周期性活动形式存在的异常神经活动（我们在此将其称为发作期 - 发作间期连续异常，即IICA）是否与迟发性脑缺血（DCI）相关。
对124例中重度蛛网膜下腔出血（SAH）患者的连续脑电图（cEEG）报告和病历进行回顾性分析。我们确定了癫痫发作和IICA的每日发生情况。使用生存分析方法，我们估计了有和没有迟发性脑缺血（DCI）的患者IICA发作时间的累积概率。
我们的数据表明，IICA的存在确实增加了发生DCI的风险，尤其是当它们在SAH发作几天后开始出现时。我们发现，除了广泛性节律性δ活动外，所有IICA类型在发生DCI的患者中更为常见。特别是，住院后期开始出现的IICA与DCI风险增加相关。
IICA是识别DCI风险增加的早期患者的一个新标志物。此外，IICA可能在机制上导致DCI，因此代表了预防SAH后继发性脑损伤的一个新的潜在干预靶点。
这些发现意味着IICA可能是预测发生DCI风险较高者的一个新标志物。
