Aquino Lia, Kang Christopher Y, Harada Megan Y, Ko Ara, Do-Nguyen Amy, Ley Eric J, Margulies Daniel R, Alban Rodrigo F
Am Surg. 2017 Dec 1;83(12):1433-1437.
Severe traumatic brain injury (TBI) is associated with increased risk for early clinical and subclinical seizures. The use of continuous electroencephalography (cEEG) monitoring after TBI allows for identification and treatment of seizures that may otherwise occur undetected. Benefits of "routine" cEEG after TBI remain controversial. We examined the rate of subclinical seizures identified by cEEG in TBI patients admitted to a Level I trauma center. We analyzed a cohort of trauma patients with moderate to severe TBI (head Abbreviated Injury Score ≥3) who received cEEG within seven days of admission between October 2011 and May 2015. Demographics, clinical data, injury severity, and costs were recorded. Clinical characteristics were compared between those with and without seizures as identified by cEEG. A total of 106 TBI patients with moderate to severe TBI received a cEEG during the study period. Most were male (74%) with a mean age of 55 years. Subclinical seizures were identified by cEEG in only 3.8 per cent of patients. Ninety-three per cent were on antiseizure prophylaxis at the time of cEEG. Patients who had subclinical seizures were significantly older than their counterparts (80 vs 54 years, P = 0.03) with a higher mean head Abbreviated Injury Score (5.0 vs 4.0, P = 0.01). Mortality and intensive care unit stay were similar in both groups. Of all TBI patients who were monitored with cEEG, seizures were identified in only 3.8 per cent. Seizures were more likely to occur in older patients with severe head injury. Given the high cost of routine cEEG and the low incidence of subclinical seizures, we recommend cEEG monitoring only when clinically indicated.
重度创伤性脑损伤（TBI）与早期临床和亚临床癫痫发作风险增加相关。创伤性脑损伤后使用连续脑电图（cEEG）监测有助于识别和治疗那些可能未被发现而发生的癫痫发作。创伤性脑损伤后“常规”cEEG的益处仍存在争议。我们研究了入住一级创伤中心的TBI患者中通过cEEG识别出的亚临床癫痫发作率。我们分析了一组2011年10月至2015年5月期间入院后7天内接受cEEG检查的中度至重度TBI（头部简明损伤评分≥3）创伤患者队列。记录了人口统计学、临床数据、损伤严重程度和费用。比较了通过cEEG识别出有癫痫发作和无癫痫发作患者的临床特征。在研究期间，共有106例中度至重度TBI患者接受了cEEG检查。大多数为男性（74%），平均年龄55岁。仅3.8%的患者通过cEEG识别出亚临床癫痫发作。93%的患者在进行cEEG检查时正在接受抗癫痫预防治疗。有亚临床癫痫发作的患者比无癫痫发作的患者年龄显著更大（80岁对54岁，P = 0.03），平均头部简明损伤评分更高（5.0对4.0，P = 0.01）。两组的死亡率和重症监护病房住院时间相似。在所有接受cEEG监测的TBI患者中，仅3.8%识别出癫痫发作。癫痫发作更可能发生在老年重度颅脑损伤患者中。鉴于常规cEEG成本高且亚临床癫痫发作发生率低，我们建议仅在临床有指征时进行cEEG监测。
