Peedicail Joseph, Mehdiratta Neil, Zhu Shenghua, Nedjadrasul Paulina, Ng Marcus C
Section of Neurology, University of Manitoba, Winnipeg, MB, Canada.
Department of Radiology, University of Ottawa, Ottawa, ON, Canada.
Clin Neurophysiol Pract. 2021 Nov 1;6:275-280. doi: 10.1016/j.cnp.2021.10.003. eCollection 2021.
In refractory status epilepticus (RSE), the optimal degree of suppression (EEG burst suppression or merely suppressing seizures) remains unknown. Many centers lacking continuous EEG must default to serial intermittent recordings where uncertainty from lack of data may prompt more aggressive suppression. In this study, we sought to determine whether the quantitative burst suppression ratio (QBSR) from serial intermittent EEG recording is associated with RSE patient outcome.
We screened the EEG database to identify non-anoxic adult RSE patients for EEG and chart review. QBSR was calculated per 10-second EEG epoch as the percentage of time during which EEG amplitude was <3 µV. Patients who survived 1-3 months after discharge from ICU and hospital comprised the favorable group. Further to initial unadjusted univariate analysis of all pooled QBSR, we conducted multivariate analyses to account for individual patient confounders ("per-capita analysis"), uneven number of EEG recordings ("per-session analysis"), and uneven number of epochs ("per-epoch analysis"). We analyzed gender, anesthetic number, and adjusted status epilepticus severity score (aSTESS) as confounders.
In 135,765 QBSR values over 160 EEG recordings (median 2.17 h every ≥24 h) from 17 patients on Propofol, Midazolam, and/or Ketamine, QBSR was deeper in the favorable group ( < 0.001) on initial unadjusted analysis. However, on adjusted multivariate analysis, there was consistently no association between QBSR and outcome. Higher aSTESS consistently associated with unfavorable outcome on per-capita (p = 0.033), per-session (p = 0.048) and per-epoch (p < 0.001) analyses. Greater maximal number of non-barbiturate anesthetic associated with favorable outcome on per-epoch analysis (p < 0.001).
There was no association between depth of EEG suppression using non-barbiturate anesthetic and RSE patient outcome based on QBSR from serial intermittent EEG. A per-epoch association between non-barbiturate anesthetic and favorable outcome suggests an effect from non-suppressive time-varying EEG content.
Targeting and following deeper burst suppression through non-barbiturate anesthetics on serial intermittent EEG monitoring of RSE is of limited utility.
在难治性癫痫持续状态（RSE）中，最佳抑制程度（脑电图爆发抑制或仅仅是抑制癫痫发作）仍不明确。许多缺乏连续脑电图监测的中心不得不采用系列间歇性记录，而数据缺失带来的不确定性可能促使采取更积极的抑制措施。在本研究中，我们试图确定系列间歇性脑电图记录中的定量爆发抑制率（QBSR）是否与RSE患者的预后相关。
我们筛查脑电图数据库，以识别非缺氧性成年RSE患者，进行脑电图和病历审查。每10秒脑电图时段计算QBSR，即脑电图振幅<3µV的时间百分比。从重症监护病房（ICU）和医院出院后存活1 - 3个月的患者组成预后良好组。除了对所有汇总的QBSR进行初始未调整单因素分析外，我们还进行多因素分析，以考虑个体患者混杂因素（“人均分析”）、脑电图记录数量不均（“每次记录分析”）以及时段数量不均（“每个时段分析”）。我们分析性别、麻醉次数和调整后的癫痫持续状态严重程度评分（aSTESS）作为混杂因素。
在17例使用丙泊酚、咪达唑仑和/或氯胺酮的患者的160次脑电图记录（每≥24小时中位数为2.17小时）中得到的135,765个QBSR值，初始未调整分析显示预后良好组的QBSR更深（<0.001）。然而，在调整后的多因素分析中，QBSR与预后始终无关联。在人均分析（p = 0.033）、每次记录分析（p = 0.048）和每个时段分析（p < 0.001）中，较高的aSTESS始终与不良预后相关。在每个时段分析中，非巴比妥类麻醉剂的最大数量较多与良好预后相关（p < 0.001）。
基于系列间歇性脑电图的QBSR，使用非巴比妥类麻醉剂进行脑电图抑制的深度与RSE患者的预后之间无关联。非巴比妥类麻醉剂与良好预后之间的每个时段关联表明非抑制性随时间变化的脑电图内容产生了影响。
在RSE的系列间歇性脑电图监测中，通过非巴比妥类麻醉剂靶向并追求更深程度的爆发抑制效用有限。
