Department of Internal Medicine, University of California, Irvine School of Medicine, Orange, CA, USA; Department of Internal Medicine, University of California, Irvine School of Medicine, Orange, CA, USA.
Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
Clin Neurophysiol. 2021 Apr;132(4):977-983. doi: 10.1016/j.clinph.2020.12.018. Epub 2021 Jan 28.
Postictal generalized electroencephalographic suppression (PGES) has been defined as electroencephalographic (EEG) activity of less than 10 microvolts following a generalized seizure. PGES is associated with an increased risk of sudden unexplained death in epilepsy, as well as treatment efficacy of electroconvulsive therapy (ECT). We investigated the impact of anesthetic on PGES expression and temporal characteristics.
We recorded postictal EEG in 50 ECT sessions in 11 patients with treatment resistant depression (ClinicalTrials.gov NCT02761330). For each participant, repeated sessions included either ketamine or etomidate general anesthesia during ECT. An automated algorithm was employed to detect PGES within 5 minutes after seizure termination.
PGES was detected in 31/50 recordings, with intermittent epochs recurring up to five minutes after seizure termination. PGES total duration was greater following ketamine than etomidate anesthesia (p = 0.04). PGES expression declined loglinearly as a function of time (r = -0.89, p < 10). EEG amplitude during PGES did not vary linearly with time.
PGES can occur intermittently for several minutes following seizure termination. Anesthetic effects should be considered when correlating PGES duration to clinical outcomes.
Prolonged EEG monitoring several minutes following seizure termination may be necessary to fully evaluate the presence and total duration of PGES.
癫痫发作后出现的全身性脑电图抑制（PGES）定义为全身性癫痫发作后脑电图（EEG）活动低于 10 微伏。PGES 与癫痫患者不明原因猝死风险增加以及电惊厥治疗（ECT）的疗效相关。我们研究了麻醉对 PGES 表达和时间特征的影响。
我们在 11 例治疗抵抗性抑郁症患者的 50 次 ECT 疗程中记录了发作后 EEG。对于每个参与者，重复疗程包括 ECT 期间使用氯胺酮或依托咪酯全身麻醉。使用自动算法在癫痫发作停止后 5 分钟内检测 PGES。
在 50 次记录中有 31 次检测到 PGES，间歇性时段在癫痫发作停止后长达五分钟重复出现。PGES 总持续时间在氯胺酮麻醉后比依托咪酯麻醉后更长（p=0.04）。PGES 的表达随时间呈对数线性下降（r=-0.89，p<10）。PGES 期间的 EEG 振幅与时间不成线性关系。
癫痫发作停止后，PGES 可能间歇性地持续数分钟。在将 PGES 持续时间与临床结果相关联时，应考虑麻醉效果。
在充分评估 PGES 的存在和总持续时间时，可能需要在癫痫发作停止后进行数分钟的延长 EEG 监测。
