连续脑电监测危重症患者癫痫发作的独立危险因素。

Independent risk factors for seizures in critically ill patients on continuous EEG.

机构信息

Department of Clinical Neurophysiology, Hospital Israelita Albert Einstein, São Paulo, Brazil.

出版信息

Epileptic Disord. 2022 Apr 1;24(2):287-294. doi: 10.1684/epd.2021.1388.

DOI:10.1684/epd.2021.1388

PMID:34825889

Abstract

OBJECTIVE

The objective of this study was to characterize the independent risk factors for seizures in critically ill patients monitored with continuous EEG (cEEG).

METHODS

We retrospectively investigated variables associated with cEEG seizures, first in the entire cohort of 156 patients and, subsequently, in the subgroup without seizures in the first 30 minutes of monitoring.

RESULTS

Seizures were observed in 19.2% of recordings, and in 50% of these, seizures occurred in the first 30 minutes. In the entire cohort, epilepsy, acute seizures prior to cEEG, interictal epileptiform discharges (IEDs), lateralized periodic discharges (LPDs), and brief potentially ictal rhythmic discharges (BIRDs) were associated with a higher incidence of cEEG seizures, whereas coma, intravenous anaesthetic drugs, and generalized periodic discharges (GPDs) were associated with a lower incidence of seizures. On multivariate analysis, this association was maintained for acute seizures before cEEG (OR: 5.92) and IEDs (OR: 6.81). Excluding patients with seizures at the beginning of monitoring, acute seizures before cEEG, IEDs, LPDs, and BIRDs were associated with an increased risk of seizures. The presence of IEDs or LPDs in the first 30 minutes was associated with a 4.14-fold greater chance of seizures on cEEG. On multivariate analysis, acute seizures prior to recording (OR 7.29) and LPDs (OR: 5.38) remained associated with seizures on cEEG. Due to the sample size, BIRDs were not included in multivariate models.

SIGNIFICANCE

Acute seizures prior to monitoring, IEDs, LPDs and BIRDs are important risk factors for cEEG seizures in critically ill patients.

摘要

目的

本研究旨在描述接受连续脑电图（cEEG）监测的危重症患者癫痫发作的独立危险因素。

方法

我们回顾性调查了与 cEEG 癫痫发作相关的变量，首先在 156 例患者的整个队列中进行，随后在监测前 30 分钟内无癫痫发作的亚组中进行。

结果

19.2%的记录中观察到癫痫发作，其中 50%的癫痫发作发生在监测的前 30 分钟内。在整个队列中，癫痫、cEEG 前急性癫痫发作、发作间期癫痫样放电（IEDs）、偏侧周期性放电（LPDs）和短暂潜在癫痫发作性节律放电（BIRDs）与 cEEG 癫痫发作发生率较高相关，而昏迷、静脉麻醉药物和全面性周期性放电（GPDs）与癫痫发作发生率较低相关。多变量分析显示，cEEG 前急性癫痫发作（OR：5.92）和 IEDs（OR：6.81）与癫痫发作的相关性仍然存在。排除监测开始时就有癫痫发作的患者后，cEEG 前急性癫痫发作、IEDs、LPDs 和 BIRDs 与癫痫发作风险增加相关。在监测的前 30 分钟内出现 IEDs 或 LPDs 与 cEEG 上出现癫痫发作的可能性增加 4.14 倍相关。多变量分析显示，记录前急性癫痫发作（OR 7.29）和 LPDs（OR：5.38）与 cEEG 上的癫痫发作仍然相关。由于样本量的限制，BIRDs 未纳入多变量模型。