警惕意识障碍持续时间较长的非惊厥性发作：长期 EEG 监测是关键。

Beware of nonconvulsive seizures in prolonged disorders of consciousness: Long-term EEG monitoring is the key.

机构信息

William Lennox Neurological Hospital (WLNH), Ottignies, Belgium; Refractory Epilepsy Reference Center, Université Catholique de Louvain (UCLouvain) - Saint-Luc University Hospital, Belgium.

Neurology Department and Refractory Epilepsy Reference Center, Université Libre de Bruxelles (ULB) - Erasme University Hospital, Brussels, Belgium, Department of Neurology - Yale University School of Medicine, New Haven, CT, USA.

出版信息

Clin Neurophysiol. 2022 Apr;136:228-234. doi: 10.1016/j.clinph.2021.12.020. Epub 2022 Jan 25.

DOI:10.1016/j.clinph.2021.12.020

PMID:35220161

Abstract

OBJECTIVE

Evaluate the prevalence of epileptic seizures (ES) and epileptiform discharges (EDs) in patients with prolonged disorders of consciousness (DOC), and potential influence of amantadine on epilepsy.

METHODS

We conducted a retrospective study in 34 patients hospitalized in a DOC care unit for prolonged DOC between 2012 and 2018, who received a long-term EEG monitoring (LTM). We reviewed the prevalence of ES, EDs and nonconvulsive seizures (NCSz), the type of DOC recovery treatment administered, and neurological outcome.

RESULTS

LTM was more effective than standard EEGs in detecting EDs (32% vs 21% respectively). Moreover, 12% of the LTM showed NCSz. Among patients with EDs in LTM, 73% showed no EDs in standard EEG recordings, even when performed more than once. The presence of EDs and/or NCSz in LTM was significantly associated with the occurrence of remote clinical epileptic seizures (p = 0.017) but did not influence neurological outcome (p = 1). Amantadine was not associated with higher occurrence of EDs/NCSz or clinical seizures.

CONCLUSION

In our prolonged DOC population, LTM showed more pathological results (EDs and NCSz) than standard EEGs, which was significantly associated with remote clinical seizures.

SIGNIFICANCE

The use of LTM might be advised to rule out NCSz in patients with prolonged DOC.

摘要

目的

评估长程意识障碍（DOC）患者中癫痫发作（ES）和癫痫样放电（EDs）的发生率，以及金刚烷胺对癫痫的潜在影响。

方法

我们对 2012 年至 2018 年间在 DOC 护理单元住院的 34 例长程 DOC 患者进行了回顾性研究，这些患者接受了长程脑电图监测（LTM）。我们回顾了 ES、EDs 和非惊厥性癫痫发作（NCSz）的发生率、DOC 恢复治疗的类型以及神经结局。

结果

LTM 比标准 EEG 更有效地检测 EDs（分别为 32%和 21%）。此外，LTM 的 12%显示出 NCSz。在 LTM 中出现 EDs 的患者中，73%的患者在标准 EEG 记录中无 EDs，即使记录多次。LTM 中存在 EDs 和/或 NCSz 与远程临床癫痫发作的发生显著相关（p=0.017），但不影响神经结局（p=1）。金刚烷胺与 EDs/NCSz 或临床癫痫发作的发生率增加无关。