Bauerschmidt Andrew, Rubinos Clio, Claassen Jan
Department of Neurology, Columbia University, New York, New York, U.S.A.
J Clin Neurophysiol. 2018 Jul;35(4):309-313. doi: 10.1097/WNP.0000000000000464.
Use of continuous EEG monitoring in the intensive care unit setting has increased detection of not only subclinical seizures, but also patterns of discharges that have epileptiform features and periodicity yet do not meet the criteria for seizures. These periodic discharges present a clinical challenge: some patterns may reflect brain injury that has already occurred, although there is evidence that some periodic discharges represent an ongoing process causing additional brain injury and necessitate treatment. Herein, we review the available data regarding the clinical significance of different categories of periodic discharges, specifically those that have features physiologically similar to seizures. We propose a stepwise approach to assessment and management of periodic discharges and lay out the general paradigm of (1) clinical assessment including benzodiazepine trial, (2) EEG assessment, with a focus on discharge frequency, and (3) integration of adjunctive data such as neuroimaging and metabolic data when available. A flowchart is provided to simplify and summarize this approach. The goal of this approach is to treat patterns associated with increased risk of seizures and/or additional brain injury, while avoiding unnecessary interventions.
在重症监护病房环境中使用连续脑电图监测，不仅增加了对亚临床癫痫发作的检测，还增加了对具有癫痫样特征和周期性但不符合癫痫发作标准的放电模式的检测。这些周期性放电带来了临床挑战：尽管有证据表明一些周期性放电代表正在进行的导致额外脑损伤并需要治疗的过程，但某些模式可能反映已经发生的脑损伤。在此，我们回顾了关于不同类别周期性放电临床意义的现有数据，特别是那些在生理上与癫痫发作相似的特征。我们提出了一种评估和管理周期性放电的逐步方法，并阐述了（1）包括苯二氮䓬试验在内的临床评估、（2）以放电频率为重点的脑电图评估以及（3）在可获得时整合辅助数据（如神经影像学和代谢数据）的一般范式。提供了一个流程图以简化和总结此方法。该方法的目标是治疗与癫痫发作风险增加和/或额外脑损伤相关的模式，同时避免不必要的干预。
