Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia.
Epilepsy Behav. 2023 Apr;141:109144. doi: 10.1016/j.yebeh.2023.109144. Epub 2023 Feb 28.
To highlight the importance of routine electroencephalogram (rEEG) in detecting non-convulsive status epilepticus (NCSE), describing the electroclinical spectrum and effect on outcome in critically ill patients with altered mental status (CIPAMS).
This retrospective study was conducted at King Fahd University Hospital. Clinical data and EEG recordings of CIPAMS to rule out NCSE were reviewed. All patients had at least 30 minutes of EEG recording. The Salzburg Consensus criteria (SCC) were applied to diagnose NCSE. The data analysis was performed using SPSS version 22.0. The chi-squared test was used to compare categorical variables such as etiologies, EEG findings, and functional outcomes. Multivariable analysis was performed to identify the predictors of unfavorable outcomes.
A total of 323 CIPAMS referred to rule out NCSE were enrolled (mean age 57.8 ± 20 years). Nonconvulsive status epilepticus was diagnosed in 54 (16.7%) patients. A significant association was found between subtle clinical features and NCSE (P =< 0.01). Acute ischemic stroke (18.5%), sepsis (18.5%), and hypoxic brain injury (22.2%) were the main etiologies. The previous history of epilepsy was significantly associated with NCSE (P = 0.01). Acute stroke, cardiac arrest, mechanical ventilation, and NCSE were statistically associated with unfavorable outcomes. Nonconvulsive status epilepticus was an independent predictor of unfavorable outcomes (P = 0.02, OR = 2.75, CI = 1.16-6.48) during multivariable analysis. Sepsis was associated with higher mortality (P =< 0.01, OR = 2.4, CI = 1.4-4.0).
Our study findings suggest that the utility of rEEG in detecting NCSE in CIPAMS should not be underestimated. Important observations further indicate that repeating rEEG is advisable, as this would increase the likelihood of identifying NCSE. Thus, physicians should consider and repeat rEEG when evaluating CIPAMS in order to detect NCSE, which is an independent predictor of unfavorable outcomes. Nonetheless, further studies comparing rEEG and cEEG yields are required to augment the current understanding of the electroclinical spectrum and better describe NCSE in CIPAMS.
强调常规脑电图（rEEG）在检测非惊厥性癫痫持续状态（NCSE）中的重要性，描述危重病患者意识状态改变（CIPAMS）中电临床谱和对结局的影响。
本回顾性研究在法赫德国王大学医院进行。对排除 NCSE 的 CIPAMS 的临床数据和脑电图记录进行了回顾。所有患者均至少有 30 分钟的脑电图记录。采用萨尔茨堡共识标准（SCC）诊断 NCSE。使用 SPSS 版本 22.0 进行数据分析。卡方检验用于比较病因、脑电图表现和功能结局等分类变量。进行多变量分析以确定不良结局的预测因素。
共纳入 323 例 CIPAMS 以排除 NCSE（平均年龄 57.8±20 岁）。54 例（16.7%）患者诊断为非惊厥性癫痫持续状态。细微的临床特征与 NCSE 之间存在显著相关性（P<0.01）。主要病因包括急性缺血性卒中（18.5%）、脓毒症（18.5%）和缺氧性脑损伤（22.2%）。既往癫痫病史与 NCSE 显著相关（P=0.01）。急性卒中、心搏骤停、机械通气和 NCSE 与不良结局具有统计学相关性。非惊厥性癫痫持续状态是多变量分析中不良结局的独立预测因素（P=0.02，OR=2.75，95%CI=1.16-6.48）。脓毒症与更高的死亡率相关（P<0.01，OR=2.4，95%CI=1.4-4.0）。
本研究结果表明，rEEG 在检测 CIPAMS 中的 NCSE 中的效用不应被低估。重要的观察结果进一步表明，重复 rEEG 是明智的，因为这会增加识别 NCSE 的可能性。因此，医生在评估 CIPAMS 时应考虑并重复 rEEG，以检测 NCSE，这是不良结局的独立预测因素。然而，需要进一步比较 rEEG 和 cEEG 结果的研究来增加对电临床谱的理解，并更好地描述 CIPAMS 中的 NCSE。
