Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, CT, USA; Westmead Comprehensive Epilepsy Unit, Westmead Hospital, University of Sydney, Sydney, Australia.
Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.
Clin Neurophysiol. 2023 Jun;150:98-105. doi: 10.1016/j.clinph.2023.03.011. Epub 2023 Mar 30.
To determine whether quantitative EEG analysis of burst suppression can predict seizure recurrence in patients with refractory status epilepticus (RSE) being treated with anesthetic doses of continuous IV antiseizure medications (cIVASM).
Quantitative assessment of burst suppression (including epileptiform discharges [EDs] and evolution) in 31 occasions (from 27 patients), and correlation with seizure recurrence up to 48 hours post sedative wean.
Occasions resulting in seizure recurrence (vs. no seizure recurrence) had lower burst (8.4 vs. 10.6 µV) and interburst interval (IBI) (4.2 vs. 4.8 µV) average amplitude, duration (bursts 2.8 vs. 3.6 s: IBIs 3.6 vs. 4.4 s); and burst total power (0.4 vs. 0.7 µV). Bursts (0.86 vs. 0.60) and IBIs (0.28 vs. 0.07) with EDs, higher number of EDs within bursts (mean 2.1 vs. 1.4) and IBIs (0.6 vs. 0.2), and positive evolution measures all predicted seizure recurrence, although EDs had the greatest adjusted odds ratio on multivariate analysis.
For patients in burst suppression, successful wean of cIVASM was not determined by classical burst suppression measures, but instead how "epileptiform" bursts and IBIs were, as determined by EDs in both bursts and IBIs and surrogates for evolution within bursts.
If confirmed, these objective measures could be used during clinical care to help determine when to wean cIVASM in patients with RSE.
确定接受麻醉剂量持续 IV 抗癫痫药物（cIVASM）治疗的难治性癫痫持续状态（RSE）患者中，爆发抑制的定量脑电图分析是否可预测癫痫发作复发。
对 31 个发作（来自 27 名患者）进行爆发抑制的定量评估（包括癫痫样放电 [EDs] 和演变），并与镇静剂撤药后 48 小时内的癫痫复发相关。
导致癫痫发作复发（vs. 无癫痫发作复发）的发作中，爆发（8.4 对 10.6 µV）和爆发间间隔（IBI）（4.2 对 4.8 µV）平均幅度较低，持续时间（爆发 2.8 对 3.6 s：IBIs 3.6 对 4.4 s）和爆发总功率（0.4 对 0.7 µV）较低。爆发（0.86 对 0.60）和 IBI（0.28 对 0.07）中有 EDs，爆发和 IBI 内的 EDs 数量更多（平均 2.1 对 1.4 和 0.6 对 0.2），以及正的演变测量值均预测了癫痫发作复发，尽管 EDs 在多变量分析中具有最大的调整比值比。
对于处于爆发抑制的患者，cIVASM 的成功撤药不是由经典的爆发抑制测量值决定的，而是由爆发和 IBI 中的 EDs 以及爆发内的演变替代物决定的。
如果得到证实，这些客观指标可用于临床护理中，帮助确定 RSE 患者何时撤用 cIVASM。
