Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA.
Division of Critical Care, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Neurocrit Care. 2019 Feb;30(1):207-215. doi: 10.1007/s12028-018-0599-4.
Clinical seizures and status epilepticus are frequent complications of encephalitis, can lead to depressed level of consciousness, and are associated with poor outcome. We sought to determine the frequency, risk factors, and clinical impact of electrographic seizures detected with continuing electroencephalography (cEEG) in patients with encephalitis and altered level of consciousness.
We retrospectively identified all patients with presumed or definite viral or autoimmune encephalitis who underwent cEEG monitoring at Henry Ford Hospital from January 2012 to October 2017. Clinical data and cEEG monitoring reports were abstracted and recorded. The primary outcome was electrographic seizures detected by cEEG.
Of 1,735 patients who underwent a minimum of 12 h of cEEG monitoring, we identified 54 with a verified discharge diagnosis of encephalitis. Twenty-two of these patients (41%) had electrographic seizures on cEEG. Compared with encephalitis patients without seizures, electrographic seizures were associated with lower serum sodium levels (137 ± 5 vs 141 ± 7, P = 0.027) and more often were on antiepileptic therapy (100% vs 78%, P = 0.033) on the first day of monitoring. Seizures were also associated with a higher frequency of cortical imaging abnormalities (68% vs 28%, P = 0.005), lateralized periodic discharges (LPDs; 50% vs 16%, P = 0.014), delta background frequency (81% vs 45%, P = 0.010), low or suppressed voltage (96% vs 62%, P = 0.005), and focal slowing (86% vs 47%, P = 0.004). There was no association between electrographic seizures and clinical outcome at discharge.
Electrographic seizures occur in approximately 40% of patients with acute encephalitis. Low serum sodium, cortical imaging abnormalities, and on cEEG LPDs and background abnormalities are associated factors. The lack of association with short-term outcome suggests that with aggressive treatment, the clinical impact of electrographic seizures in encephalitis can be minimized.
临床发作和癫痫持续状态是脑炎的常见并发症，可导致意识水平降低，并与不良预后相关。我们旨在确定在意识改变的脑炎患者中，通过连续脑电图（cEEG）检测到的脑电图发作的频率、危险因素和临床影响。
我们回顾性地确定了 2012 年 1 月至 2017 年 10 月期间在亨利福特医院接受 cEEG 监测的疑似或明确病毒性或自身免疫性脑炎的所有患者。提取并记录临床数据和 cEEG 监测报告。主要结局是 cEEG 检测到的脑电图发作。
在接受至少 12 小时 cEEG 监测的 1735 名患者中，我们确定了 54 名经证实患有脑炎的出院诊断。这些患者中有 22 名（41%）在 cEEG 上出现脑电图发作。与无癫痫发作的脑炎患者相比，脑电图发作与较低的血清钠水平（137±5 与 141±7，P=0.027）和更常接受抗癫痫治疗（100%与 78%，P=0.033）有关。在监测的第一天。癫痫发作也与皮质影像学异常（68%与 28%，P=0.005）、局灶性周期性放电（LPD；50%与 16%，P=0.014）、δ背景频率（81%与 45%，P=0.010）、低或抑制电压（96%与 62%，P=0.005）和局灶性减慢（86%与 47%，P=0.004）的发生率较高相关。脑电图发作与出院时的临床结局无相关性。
约 40%的急性脑炎患者出现脑电图发作。低血清钠、皮质影像学异常以及 cEEG LPD 和背景异常是相关因素。与短期预后无关联表明，通过积极治疗，可以最大限度地减少脑炎中脑电图发作的临床影响。
