Newey Christopher R, Kinzy Tyler G, Punia Vineet, Hantus Stephen
Cleveland Clinic, Epilepsy Center, Neurological Institute, Cleveland, Ohio, U.S.A.
Cleveland Clinic, Cerebrovascular Center, Neurological Institute, Cleveland, Ohio, U.S.A.
J Clin Neurophysiol. 2018 Jul;35(4):325-331. doi: 10.1097/WNP.0000000000000475.
Electrographic seizures detected by continuous electroencephalography (CEEG) in critically ill patients with altered mental status is becoming increasingly recognized. Data guiding the appropriate selection of patients to be monitored on CEEG are lacking. The aims of this article were to study the incidence of seizures in the critical care setting and to evaluate for clinical predictors to improve the efficiency of CEEG monitoring.
Retrospective review of the CEEG and clinical data on 1,123 consecutive patients who had continuous video EEG over a 24-month period.
Seizures were recorded in 215 patients on CEEG monitoring (19.1%). In total, 89.3% of these seizures occurred without clinical signs. Patients who were in a coma were more likely to have EEG seizures (odds ratio, 3.64; 95% confidence interval, 2.23-5.95) compared with those awake. The incidence of seizures was overrepresented in patients with extra-axial tumors (41.9%), multiple sclerosis (35.7%), and intra-axial tumors (33.0%). Lateralized periodic discharges were predictive (odds ratio, 8.27; 95% confidence interval, 5.52-12.46) of seizure occurrence compared with those with no epileptiform patterns. Only generalized periodic discharges with triphasic morphology had no increased odds of seizure (odds ratio, 1.02; 95% confidence interval, 0.24-3.03). When present, electroencephalography seizures were detected within 24 hours in 92% of monitored patients.
Continuous electroencephalography monitoring in the critical care setting demonstrates a linear increase in seizure incidence with declining mental status. Recognizing clinical conditions and electroencephalography markings may help in the appropriate selection of critically ill patients for CEEG monitoring.
在精神状态改变的重症患者中，通过持续脑电图（CEEG）检测到的脑电图癫痫发作越来越受到认可。目前缺乏指导合适患者进行CEEG监测选择的数据。本文旨在研究重症监护环境中癫痫发作的发生率，并评估临床预测因素以提高CEEG监测的效率。
回顾性分析1123例连续患者在24个月期间进行的连续视频脑电图及临床数据。
在CEEG监测中，215例患者记录到癫痫发作（19.1%）。其中，89.3%的癫痫发作无临床体征。与清醒患者相比，昏迷患者更易出现脑电图癫痫发作（优势比，3.64；95%置信区间，2.23 - 5.95）。轴外肿瘤患者（41.9%）、多发性硬化患者（35.7%）和轴内肿瘤患者（33.0%）的癫痫发作发生率过高。与无癫痫样模式的患者相比，侧化周期性放电可预测癫痫发作的发生（优势比，8.27；95%置信区间，5.52 - 12.46）。只有三相形态的全身性周期性放电癫痫发作几率未增加（优势比，1.02；95%置信区间，0.24 - 3.03）。当出现脑电图癫痫发作时，92%的监测患者在24小时内被检测到。
重症监护环境中的持续脑电图监测表明，癫痫发作发生率随精神状态下降呈线性增加。识别临床情况和脑电图特征可能有助于为重症患者选择合适的CEEG监测。
