非工作时间脑电图：急诊常规脑电图与延长脑电图记录的相对价值

After-Hours EEG: Relative Value of Emergent Routine Versus Prolonged EEG Recordings.

作者信息

Singh Jaysingh, Britton Jeffrey, Alwaki Abdulrahman, Singh Priti

机构信息

The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.

Mayo Clinic, Rochester, Minnesota, U.S.A.

出版信息

J Clin Neurophysiol. 2019 Jan;36(1):32-35. doi: 10.1097/WNP.0000000000000529.

DOI:10.1097/WNP.0000000000000529

PMID:30608366

Abstract

OBJECTIVE

After-hours EEG is increasingly used in hospital patients. Although the detection of seizures and interictal epileptiform discharges has been shown to be higher with prolonged EEG (pEEG) than routine-duration EEG, the relative value for particular indications can inform utilization.

METHOD

The Mayo EEG Report System was queried for after-hours emergent routine EEG (ErEEG) and pEEG performed between January 2015 and June 2015. Total 296 after-hours ErEEG were identified, of which 140 converted into pEEG were included in the study for direct comparison of two modalities. Indications were categorized as: mental status changes, recent seizures rule out continued nonconvulsive seizures, spells, and prognosis after anoxic brain injury. Categorical data were analyzed using the McNemar and Fisher exact tests; a P value of 0.05 was considered significant.

RESULT

Prolonged EEG was superior to ErEEG for detection of interictal epileptiform discharges (61 vs. 48/140, P = 0.004) and seizures (29 vs. 17/140, P = 0.012). Seizure detection was greater for pEEG than ErEEG for the indication of evaluating for subclinical seizures after recent observed clinical seizures (14/41 [34.1%] versus 4/41 [9.8%], P = 0.002). There was no significant difference between modalities for seizure detection in patients undergoing evaluation of spells or mental status changes without previous observed seizures. Detection of seizures on pEEG was higher for recordings greater than 24 hours (8/46, 17%, P = 0.014) and 48 hours (19/26, 73%, P < 0.001) than recordings less than 24 hours (2/68, 3%). Seizure detection was higher with pEEG in comatose patients than ErEEG (17/51, 33% vs. 12/89, 13%; P = 0.009).

CONCLUSIONS

Increased value was demonstrated for pEEG over ErEEG in patients undergoing evaluation after observed recent clinical seizures and for coma. No significant difference was found between ErEEG and pEEG for seizure detection in the relatively small subgroups of patients with mental status changes other than coma and without preceding seizure or spells.

摘要

目的

非工作时间脑电图（EEG）在住院患者中的应用越来越广泛。虽然延长脑电图（pEEG）检测癫痫发作和发作间期癫痫样放电的能力已被证明高于常规时长脑电图，但特定适应证的相对价值有助于指导其应用。

方法

查询梅奥脑电图报告系统，获取2015年1月至2015年6月期间非工作时间进行的紧急常规脑电图（ErEEG）和pEEG记录。共识别出296例非工作时间的ErEEG，其中140例转为pEEG的纳入研究，用于两种模式的直接比较。适应证分为：精神状态改变、近期癫痫发作以排除持续性非惊厥性癫痫、发作性症状，以及缺氧性脑损伤后的预后评估。分类数据采用McNemar检验和Fisher精确检验进行分析；P值<0.05被认为具有统计学意义。

结果

在检测发作间期癫痫样放电（61/140对48/140，P = 0.004）和癫痫发作（29/140对17/140，P = 0.012）方面，pEEG优于ErEEG。对于近期有临床癫痫发作后评估亚临床癫痫发作的适应证，pEEG的癫痫发作检测率高于ErEEG（14/41 [34.1%]对4/41 [9.8%]，P = 0.002）。在对发作性症状或精神状态改变且既往无癫痫发作的患者进行评估时，两种模式在癫痫发作检测方面无显著差异。pEEG记录超过24小时（8/46，17%，P = 0.014）和48小时（19/26，73%，P < 0.001）的癫痫发作检测率高于记录少于24小时的（2/68，3%）。昏迷患者中，pEEG的癫痫发作检测率高于ErEEG（17/51，33%对12/89，13%；P = 0.009）。