Beth Israel Deaconess Medical Center, Department of Neurology, Harvard Medical School, Boston, MA.
Boston Medical Center, Department of Neurology, Boston, MA.
Ann Neurol. 2021 May;89(5):872-883. doi: 10.1002/ana.26060. Epub 2021 Mar 24.
The aim was to determine the prevalence and risk factors for electrographic seizures and other electroencephalographic (EEG) patterns in patients with Coronavirus disease 2019 (COVID-19) undergoing clinically indicated continuous electroencephalogram (cEEG) monitoring and to assess whether EEG findings are associated with outcomes.
We identified 197 patients with COVID-19 referred for cEEG at 9 participating centers. Medical records and EEG reports were reviewed retrospectively to determine the incidence of and clinical risk factors for seizures and other epileptiform patterns. Multivariate Cox proportional hazards analysis assessed the relationship between EEG patterns and clinical outcomes.
Electrographic seizures were detected in 19 (9.6%) patients, including nonconvulsive status epilepticus (NCSE) in 11 (5.6%). Epileptiform abnormalities (either ictal or interictal) were present in 96 (48.7%). Preceding clinical seizures during hospitalization were associated with both electrographic seizures (36.4% in those with vs 8.1% in those without prior clinical seizures, odds ratio [OR] 6.51, p = 0.01) and NCSE (27.3% vs 4.3%, OR 8.34, p = 0.01). A pre-existing intracranial lesion on neuroimaging was associated with NCSE (14.3% vs 3.7%; OR 4.33, p = 0.02). In multivariate analysis of outcomes, electrographic seizures were an independent predictor of in-hospital mortality (hazard ratio [HR] 4.07 [1.44-11.51], p < 0.01). In competing risks analysis, hospital length of stay increased in the presence of NCSE (30 day proportion discharged with vs without NCSE: HR 0.21 [0.03-0.33] vs 0.43 [0.36-0.49]).
This multicenter retrospective cohort study demonstrates that seizures and other epileptiform abnormalities are common in patients with COVID-19 undergoing clinically indicated cEEG and are associated with adverse clinical outcomes. ANN NEUROL 2021;89:872-883.
确定在因临床指征行连续脑电图（cEEG）监测的 2019 冠状病毒病（COVID-19）患者中，出现电发作和其他脑电图（EEG）模式的患病率和危险因素，并评估这些脑电图发现是否与结局相关。
我们在 9 个参与中心识别了 197 例因 COVID-19 而接受 cEEG 的患者。回顾性查阅病历和脑电图报告，以确定发作和其他癫痫样模式的发生率和临床危险因素。多变量 Cox 比例风险分析评估了 EEG 模式与临床结局之间的关系。
19 例（9.6%）患者检测到电发作，包括非惊厥性癫痫持续状态（NCSE）11 例（5.6%）。96 例（48.7%）存在癫痫样异常（无论是发作期还是发作间期）。住院期间出现临床前发作与电发作（有 vs 无临床前发作者为 36.4% vs 8.1%，优势比[OR] 6.51，p = 0.01）和 NCSE（27.3% vs 4.3%，OR 8.34，p = 0.01）均相关。神经影像学上存在颅内病变与 NCSE 相关（14.3% vs 3.7%；OR 4.33，p = 0.02）。在结局的多变量分析中，电发作是院内死亡的独立预测因素（风险比[HR] 4.07 [1.44-11.51]，p<0.01）。在竞争风险分析中，NCSE 存在时住院时间延长（30 天出院比例：有 NCSE 者 vs 无 NCSE 者为 HR 0.21 [0.03-0.33] vs 0.43 [0.36-0.49]）。
这项多中心回顾性队列研究表明，在因临床指征行 cEEG 的 COVID-19 患者中，发作和其他癫痫样异常很常见，并且与不良临床结局相关。
