Yoo Ji Yeoun, Marcuse Lara V, Fields Madeline C, Rosengard Jillian L, Traversa Maria Vittoria, Gaspard Nicolas, Hirsch Lawrence J
*Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.; †Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, U.S.A.; and ‡Department of Neurology, Université Libre de Bruxelles, Brussels, Belgium.
J Clin Neurophysiol. 2017 May;34(3):222-229. doi: 10.1097/WNP.0000000000000357.
Brief potentially ictal rhythmic discharges (B(I)RDs) have been described in neonates and critically ill adults, and their association with seizures has been demonstrated. Their significance in noncritically ill adults remains unclear. We aimed to investigate their prevalence, electrographic characteristics, and clinical significance.
We identified adult patients with B(I)RDs who received long-term EEG recordings either in the epilepsy monitoring unit or in the ambulatory setting. Patients with acute findings on imaging or status epilepticus were excluded. B(I)RDs were defined as very brief (<10 seconds) runs of focal or generalized sharply contoured rhythmic activity greater than 4 Hz, with or without evolution, that were not consistent with any known normal or benign pattern. The clinical history, EEG, and imaging results were retrieved. Each patient with B(I)RDs was matched by age and etiology to a control group with epileptiform discharges but without B(I)RDs in a 1:2 ratio.
We identified B(I)RDs in 15 patients of 1,230 EEGs (1.2%). The pattern typically consisted of 0.5 to 4 second runs of sharply contoured alpha activity without evolution. All patients with B(I)RDs had epilepsy, and, when compared with controls with epilepsy but without BIRDs, were more likely to be medically refractory (10 of 15 [67%] vs. 5 of 30 [17%]; P < 0.01). All seizure onsets colocalized to the B(I)RDs, and most were morphologically similar.
In noncritically ill patients, B(I)RDs are associated with refractory epilepsy and their location is correlated with the seizure onset area.
短暂性潜在发作性节律性放电（B(I)RDs）已在新生儿和重症成人中被描述，并且已证实其与癫痫发作有关。它们在非重症成人中的意义仍不明确。我们旨在研究其发生率、脑电图特征及临床意义。
我们确定了在癫痫监测单元或门诊环境中接受长期脑电图记录且有B(I)RDs的成年患者。排除有急性影像学异常或癫痫持续状态的患者。B(I)RDs被定义为持续时间非常短暂（<10秒）的局灶性或全身性轮廓清晰的节律性活动，频率大于4Hz，有或无演变，且不符合任何已知的正常或良性模式。收集临床病史、脑电图和影像学结果。将每位有B(I)RDs的患者按年龄和病因以1:2的比例与有癫痫样放电但无B(I)RDs的对照组进行匹配。
在1230份脑电图中，我们在15例患者中发现了B(I)RDs（1.2%）。该模式通常由持续0.5至4秒的轮廓清晰的α活动组成，无演变。所有有B(I)RDs的患者均患有癫痫，与有癫痫但无B(I)RDs的对照组相比，更有可能药物难治（15例中的10例[67%]对30例中的5例[17%]；P<0.01）。所有癫痫发作起始均定位于B(I)RDs处，且大多数在形态上相似。
在非重症患者中，B(I)RDs与难治性癫痫有关，其位置与癫痫发作起始区域相关。
