Department of Emergency Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, New York, U.S.A.
Department of Emergency Medicine, The University of Michigan, Ann Arbor, Michigan, U.S.A.
J Clin Neurophysiol. 2022 Sep 1;39(6):441-445. doi: 10.1097/WNP.0000000000000800. Epub 2020 Dec 11.
It is unknown how often and how early EEG is obtained in patients presenting with status epilepticus. The Established Status Epilepticus Treatment Trial enrolled patients with benzodiazepine-refractory seizures and randomized participants to fosphenytoin, levetiracetam, or valproate. The use of early EEG, including frequency of electrographic seizures, was determined in Established Status Epilepticus Treatment Trial participants.
Secondary analysis of 475 enrollments at 58 hospitals to determine the frequency of EEG performed within 24 hours of presentation. The EEG type, the prevalence of electrographic seizures, and characteristics associated with obtaining early EEG were recorded. Chi-square and Wilcoxon rank-sum tests were calculated as appropriate for univariate and bivariate comparisons. Odds ratios are reported with 95% confidence intervals.
A total of 278 of 475 patients (58%) in the Established Status Epilepticus Treatment Trial cohort underwent EEG within 24 hours (median time to EEG: 5 hours [interquartile range: 3-10]). Electrographic seizure prevalence was 14% (95% confidence interval, 10%-19%; 39/278) in the entire cohort and 13% (95% confidence interval, 7%-21%) in the subgroup of patients meeting the primary outcome of the Established Status Epilepticus Treatment Trial (clinical treatment success within 60 minutes of randomization). Among subjects diagnosed with electrographic seizures (39), 15 (38%; 95% confidence interval, 25%-54%) had no clinical correlate on the video EEG recording.
Electrographic seizures may occur in patients who stop seizing clinically after treatment of convulsive status epilepticus. Clinical correlates might not be present during electrographic seizures. These findings support early initiation of EEG recordings in patients suffering from convulsive status epilepticus, including those with clinical evidence of treatment success.
目前尚不清楚在出现癫痫持续状态的患者中，脑电图（EEG）的获取频率和时间。在已确立的癫痫持续状态治疗试验中，纳入了苯二氮䓬类药物难治性癫痫发作的患者，并将参与者随机分配至磷苯妥英、左乙拉西坦或丙戊酸钠治疗组。本研究旨在分析已确立的癫痫持续状态治疗试验中参与者的早期 EEG （包括痫样放电的频率）使用情况。
对 58 家医院的 475 例入组患者进行二次分析，以确定就诊后 24 小时内进行 EEG 的频率。记录 EEG 类型、痫样放电的发生率以及与早期 EEG 获得相关的特征。采用卡方检验和 Wilcoxon 秩和检验分别进行单变量和双变量比较。报告比值比（OR）及其 95%置信区间（CI）。
在已确立的癫痫持续状态治疗试验队列中，共有 278 例（58%）患者在 24 小时内行 EEG（EEG 的中位时间：5 小时[四分位距：3-10]）。整个队列中痫样放电的发生率为 14%（95%CI：10%-19%；39/278），在符合已确立的癫痫持续状态治疗试验主要结局（随机分组后 60 分钟内临床治疗成功）的亚组患者中为 13%（95%CI：7%-21%）。在诊断为痫样放电的患者（39 例）中，15 例（38%；95%CI：25%-54%）的视频 EEG 记录中无临床相关表现。
在接受癫痫持续状态治疗后停止抽搐的患者中可能会出现痫样放电。在痫样放电期间可能不存在临床相关表现。这些发现支持对癫痫持续状态患者尽早开始 EEG 记录，包括那些有临床治疗成功证据的患者。
