持续脑电图监测——神经科医生的水晶球
Continuous EEG Monitoring-The Neurologist's Crystal Ball.
作者信息
Husain Aatif M
出版信息
Epilepsy Curr. 2019 Jan;19(1):24-26. doi: 10.1177/1535759718822037. Epub 2019 Jan 30.
UNLABELLED
Time to Epileptiform Activity and EEG Background Recovery Are Independent Predictors After Cardiac Arrest Westhall E, Rose I, Rundgren M, Bro-Jeppesen J, Kjaergaard J, Hassager C, Lindehammar H, Horn J, Ullen S, Nielsen N, Friberg H, Cronberg T. Clin Neurophysiol. 2018;129:1660-1668. https://doi.org/10.1016/j.clinph.2018.05.016 Objective: To investigate the temporal development of electroencephalogram (EEG) and prognosis.
METHODS
Prospective observational substudy of the Target Temperature Management trial. Six sites performed simplified continuous EEG monitoring (cEEG) on comatose patients after cardiac arrest, blinded to treating physicians. We determined time points of recovery of a normal-voltage continuous background activity and the appearance of an epileptiform EEG, defined as abundant epileptiform discharges, periodic/rhythmic discharges, or electrographic seizure activity.
RESULTS
One hundred thirty-four patients were included, of which 65 had a good outcome. Early recovery of continuous background activity (within 24 hours) occurred in 72 patients and predicted good outcome since 55 (76%) had good outcome, increasing the odds for a good outcome 7 times compared to a late background recovery. Early appearance of an epileptiform EEG occurred in 38 patients and 34 (89%) had a poor outcome, increasing the odds for a poor outcome 6 times compared to a late debut. The time to background recovery and the time to epileptiform activity were highly associated with outcome and levels of neuron-specific enolase. Multiple regression analysis showed that both variables were independent predictors.
CONCLUSIONS
Time to epileptiform activity and background recovery are independent prognostic indicators.
SIGNIFICANCE
Patients with early background recovery combined with late appearance of epileptiform activity may have a good outcome.
未加标注
心脏骤停后癫痫样活动出现时间及脑电图背景恢复情况是独立的预后预测指标
韦斯特霍尔 E、罗斯 I、伦德格伦 M、布罗 - 耶佩森 J、克亚尔加德 J、哈萨格 C、林德哈马尔 H、霍恩 J、乌伦 S、尼尔森 N、弗里贝里 H、克伦伯格 T。《临床神经生理学》。2018 年；129:1660 - 1668。https://doi.org/10.1016/j.clinph.2018.05.016 目的：研究脑电图（EEG）的时间演变及预后情况。
方法
目标体温管理试验的前瞻性观察性子研究。六个研究点对心脏骤停后的昏迷患者进行简化的连续脑电图监测（cEEG），治疗医生对此不知情。我们确定了正常电压连续背景活动恢复的时间点以及癫痫样脑电图的出现情况，癫痫样脑电图定义为大量癫痫样放电、周期性/节律性放电或脑电图发作活动。
结果
纳入 134 例患者，其中 65 例预后良好。72 例患者出现连续背景活动的早期恢复（24 小时内），且预测预后良好，因为 55 例（76%）预后良好；与背景活动恢复较晚相比，良好预后的几率增加了 7 倍。38 例患者出现癫痫样脑电图的早期出现，34 例（89%）预后不良；与出现较晚相比，不良预后的几率增加了 6 倍。背景恢复时间和癫痫样活动出现时间与预后及神经元特异性烯醇化酶水平高度相关。多元回归分析表明这两个变量都是独立的预后预测指标。
结论
癫痫样活动出现时间和背景恢复情况是独立的预后指标。
意义
背景活动早期恢复且癫痫样活动出现较晚的患者可能预后良好。
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