Paris Brain Institute, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013, Paris, France.
AP-HP, Epilepsy Unit and Clinical Neurophysiology Department (VHNM, VL, VN), Neuro-Intensive Care Unit (SD), Pitié-Salpêtrière Hospital, Paris, France.
Neurophysiol Clin. 2021 Mar;51(2):101-110. doi: 10.1016/j.neucli.2021.01.006. Epub 2021 Feb 26.
Continuous electroencephalography (EEG) is a major tool for monitoring patients admitted to the intensive care unit after refractory convulsive status epilepticus, following control of convulsive movements. We review the values of different EEG patterns observed in critically ill patients for prognosis and seizure risk, together with proposed criteria for non-convulsive status epilepticus diagnosis (Salzburg Criteria), the EEG scores for prognosis (Epidemiology-based Mortality score in Status Epilepticus, EMSE) and for seizure risk (2HELPS2B). These criteria and scores, based partially on continuous EEG, are not tailored to repetitively monitor the progressive build-up leading to seizure or status epilepticus recurrence. Therefore, we propose a new EEG-based seizure build-up score in status epilepticus (EaSiBUSSEs), based on the morphology and the prevalence of the EEG patterns observed in the follow-up of convulsive status epilepticus patients. It displays subscores from the least (no interictal activity) to the most associated with seizures (focal or generalized status epilepticus). We then evaluated the performance of the EaSiBUSSEs in a cohort of eleven patients who were admitted to intensive care unit for convulsive status epilepticus and who underwent continuous EEG recording. The receiver operating curve revealed good accuracy in identifying patients who would have seizures in the next 24 h, with excellent intra- and inter-rater reliability. We believe that this score is simple to perform, and suitable for repeated monitoring of EEG following refractory convulsive status epilepticus, with quantitative description of major EEG changes leading to seizures.
持续脑电图（EEG）是监测难治性癫痫持续状态后接受强化护理的患者的主要工具，用于控制癫痫发作后。我们回顾了危重病患者中观察到的不同 EEG 模式的预后和癫痫发作风险的价值，以及提出的非癫痫持续状态诊断标准（萨尔斯堡标准）、预后的 EEG 评分（癫痫持续状态中的基于流行病学的死亡率评分，EMSE）和癫痫发作风险的评分（2HELPS2B）。这些标准和评分部分基于连续 EEG，但并不针对反复监测导致癫痫发作或癫痫持续状态复发的渐进性进展。因此，我们提出了一种新的基于 EEG 的癫痫持续状态下癫痫发作进展评分（EaSiBUSSEs），该评分基于癫痫持续状态患者随访中观察到的 EEG 模式的形态和流行率。它显示了从最低（无发作性活动）到最相关的癫痫发作（局灶性或全面性癫痫持续状态）的亚评分。然后，我们在 11 名因癫痫持续状态而入住重症监护病房并接受连续 EEG 记录的患者中评估了 EaSiBUSSEs 的性能。接受者操作曲线显示在接下来的 24 小时内识别出癫痫发作患者的准确性良好，具有极好的内部和外部一致性。我们认为，这种评分易于执行，适合于难治性癫痫持续状态后 EEG 的重复监测，可定量描述导致癫痫发作的主要 EEG 变化。
