急危重症患者局灶性节律性 delta 活动（LRDA）与局灶性周期性放电（LPDs）的短期和长期预后比较。

Acute and Long-Term Outcomes of Lateralized Rhythmic Delta Activity (LRDA) Versus Lateralized Periodic Discharges (LPDs) in Critically Ill Patients.

机构信息

Department of Neurology, Comprehensive Epilepsy Center, Johns Hopkins University, 600 N. Wolfe St, Meyer 2-147, Baltimore, MD, USA.

出版信息

Neurocrit Care. 2021 Feb;34(1):201-208. doi: 10.1007/s12028-020-01017-y.

DOI:10.1007/s12028-020-01017-y

PMID:32556854

Abstract

BACKGROUND

To assess the acute and long-term outcomes for patients with lateralized rhythmic delta activity (LRDA) compared to patients with lateralized periodic discharges (LPDs).

METHODS

A single-center retrospective study examining consecutive patients older than 10 years who had LRDA, LPDs, or both on continuous electroencephalographic (cEEG) between 12/01/2015 and 12/31/2017. Outcomes included inpatient mortality, functional outcome at follow-up, inpatient electrographic seizures, and the presence of new epilepsy at follow-up. Patients were classified into 4 groups: LRDA-only (without LPDs), LPDs-only (without LRDA), LRDA/LPDs, and control (without LRDA or LPDs).

RESULTS

Twenty-nine patients (2.7%) were in the LRDA-only group, 76 (7%) patients were in the LPDs-only group, and 25 (2.3%) patients had both patterns (LRDA/LPDs group). 68 patients were identified as a control group. Only one patient (3%) in the LRDA-only group died during their hospitalization, compared to 21 patients (28%) in the LPDs-only group, 2 (8%) LRDA/LPDs group and 7 (10%) in the control group (p 0.003). Patients in the LPDs-only group had three times higher odds of adjusted mortality compared to the control group (p 0.05), while there was no difference in the mortality odds between the LRDA-only and control groups. Patients with LRDA-only had higher odds of good functional outcome at clinic follow-up (p 0.04). When compared to control, patients with both IIC patterns (LRDA/LPDs group) had 24.3 higher odds of acute electrographic seizures (p < 0.001), followed by patients in LPDs-only (OR 12.6, p < 0.001) and then LRDA-only (OR 9.4, p = 0.002). The odds of developing epilepsy following discharge were not increased in patients with either LRDA or LPDs (p = 0.9).

CONCLUSIONS

Patients with LRDA had superior functional outcome compared to a higher mortality for patients with LPDs. Patients with both patterns had the highest odds of acute seizures, followed by those with only LPDs and then patients with only LRDA. There was no difference in the odds of developing new epilepsy compared to control with any IIC pattern. We hypothesize different underlying mechanisms of injury leading to the observed electrographic patterns.

摘要

背景

评估与侧化周期性放电（LPDs）相比，具有侧化节律性 δ 活动（LRDA）的患者的急性和长期结局。

方法

一项单中心回顾性研究，检查了 2015 年 12 月 1 日至 2017 年 12 月 31 日期间在连续脑电图（cEEG）上出现 LRDA、LPDs 或两者的年龄大于 10 岁的连续患者。结果包括住院死亡率、随访时的功能结局、住院期间的电发作和随访时新的癫痫发作。患者被分为 4 组：仅 LRDA（无 LPDs）、仅 LPDs（无 LRDA）、LRDA/LPDs 和对照组（无 LRDA 或 LPDs）。

结果

29 例（2.7%）患者为仅 LRDA 组，76 例（7%）患者为仅 LPDs 组，25 例（2.3%）患者同时存在两种模式（LRDA/LPDs 组）。68 例患者为对照组。仅 LRDA 组中有 1 例（3%）患者在住院期间死亡，而 LPDs 组中有 21 例（28%）、LRDA/LPDs 组中有 2 例（8%）和对照组中有 7 例（10%）（p 0.003）。与对照组相比，LPDs 组患者的调整死亡率的可能性高 3 倍（p 0.05），而 LRDA 组与对照组之间的死亡率无差异。仅 LRDA 组患者在临床随访时具有更好的功能结局的可能性更高（p 0.04）。与对照组相比，同时存在两种 IIC 模式（LRDA/LPDs 组）的患者急性电发作的可能性高 24.3 倍（p<0.001），其次是仅 LPDs 组（OR 12.6，p<0.001）和仅 LRDA 组（OR 9.4，p=0.002）。LRDA 或 LPDs 患者出院后发生癫痫的可能性没有增加（p=0.9）。

结论

与 LPDs 患者相比，LRDA 患者具有更好的功能结局，但死亡率更高。同时存在两种模式的患者急性发作的可能性最高，其次是仅存在 LPDs 的患者，然后是仅存在 LRDA 的患者。与任何 IIC 模式相比，任何 IIC 模式的患者新发癫痫的可能性没有差异。我们假设导致观察到的脑电图模式的损伤的潜在机制不同。