Sinkin M V, Talypov A E, Yakovlev A A, Kordonskaya O O, Teplyshova A M, Trifonov I S, Guekht A B, Krylov V V
Sklifosovsky Research Institute of Emergenscy Medicine, Moscow, Russia.
Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2021;121(5):62-67. doi: 10.17116/jnevro202112105162.
To investigate the informativeness of long-term scalp EEG monitoring in patients with acute traumatic brain injury (TBI).
The informativity of long-term EEG monitoring (LTM) was performed in 60 patients with acute severe TBI. Odd ratios (OR) of unfavorable outcome and non-convulsive status epilepticus (NCSE) among clinical, neurophysiological and radiological features were calculated.
EEG features of the unfavorable outcome are: slowing of the dominant background rhythm below q range (OR 3.5, CI 1.2-10.7), absence of frontal-occipital gradient (OR 10.2, CI 1.89-10.12), absence of reactivity (OR 8.75, CI 2.14-35.7), absence of variability (OR 6.25, CI 1.72-22.6) and absence of NREM sleep, stage 2 (OR 5.8, CI 1.79-18.91). Clinical features associated with the unfavorable outcome are: a decrease in GCS score (OR 1.25, CI 1.07-1.47), TBI severity (OR 2.46, CI 1.16-5.18), axial dislocation (OR 4.45, CI 1.08-18.29). ORs for NCSE are significant for the following EEG features: presence of rhythmic and periodic patterns (RPP) (OR 11.92, CI 1.37-103.39), stimulus induced RPP (OR 23.14, CI 2.56-209.34), "plus" modifier (OR 4.11, CI 1.13-14.91) and electrographic evolution (OR 13.05, CI 3.59-47.39). Background rhythm slowing below q range reduces NCSE probability (OR 3.33, CI 1.09-10).
Long-term EEG monitoring is an informative tool for prognosis of outcome and diagnosis of NCSE in patients with severe TBI. The risk of NCSE increases with Marshall score but NCSE is not associated with poor outcome that requires an individual selection of intensive care.
探讨长期头皮脑电图监测在急性创伤性脑损伤（TBI）患者中的信息价值。
对60例急性重度TBI患者进行长期脑电图监测（LTM）的信息价值评估。计算临床、神经生理和放射学特征中不良结局和非惊厥性癫痫持续状态（NCSE）的比值比（OR）。
不良结局的脑电图特征为：优势背景节律减慢至q范围以下（OR 3.5，CI 1.2 - 10.7）、额枕梯度消失（OR 10.2，CI 1.89 - 10.12）、反应性缺失（OR 8.75，CI 2.14 - 35.7）、变异性缺失（OR 6.25，CI 1.72 - 22.6）和非快速眼动睡眠2期缺失（OR 5.8，CI 1.79 - 18.91）。与不良结局相关的临床特征为：格拉斯哥昏迷评分（GCS）降低（OR 1.25，CI 1.07 - 1.47）、TBI严重程度（OR 2.46，CI 1.16 - 5.18）、轴位脱位（OR 4.45，CI 1.08 - 18.29）。NCSE的OR值在以下脑电图特征方面具有统计学意义：节律性和周期性模式（RPP）的存在（OR 11.92, CI 1.37 - 103.39）、刺激诱发的RPP（OR 23.14, CI 2.56 - 209.34）、“加”修饰符（OR 4.11, CI 1.13 - 14.91）和脑电图演变（OR 13.05, CI 3.59 - 47.39）。背景节律减慢至q范围以下可降低NCSE的发生概率（OR 3.33, CI 1.09 - 10）。
长期脑电图监测是评估重度TBI患者预后和诊断NCSE的重要工具。NCSE的风险随马歇尔评分增加，但NCSE与不良结局无关，需要对重症监护进行个体化选择。
