Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany.
Department of Neurosurgery, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany.
Crit Care Med. 2023 Dec 1;51(12):1754-1765. doi: 10.1097/CCM.0000000000006033. Epub 2023 Aug 28.
Seizures and status epilepticus (SE) are frequent complications of acute subdural hematoma (aSDH) associated with increased morbidity and mortality. Therefore, we aimed to evaluate whether invasive subdural electroencephalogram recording leads to earlier seizure detection and treatment initiation in patients with aSDH.
Prospective, single-center, cohort trial.
Neurologic and neurosurgical ICUs of one academic hospital in Germany.
Patients with aSDH undergoing surgical treatment. In total, 76 patients were enrolled in this study, 31 patients (40.8%) were assigned to the invasive electroencephalogram (iEEG) monitoring group and 45 patients (59.2%) to control group.
The electrode group was implanted with a subdural strip electrode providing up to 7 days of real-time electroencephalogram recording in the neurointensive care unit, whereas the control group received regular normal surface electroencephalograms during the 7-day period. The primary outcomes were the prevalence and time to seizures and SE occurrence. Secondary outcomes included neurologic outcomes assessed using the Glasgow Outcome Scale (GOS) at discharge and 6-month follow-up and the prevalence of focal structural epilepsy within 2 years after discharge.
The trial was stopped after a study committee meeting when the prespecified criteria were met. The iEEG and control groups were well-matched for clinical characteristics at admission. Frequencies of seizures and SE detection were significantly higher in the iEEG group than in the control group (61% vs 15.6%; p < 0.001 and 38.7% vs 11.1%; p = 0.005). Time to seizure and SE detection was significantly earlier (median 29.2 vs 83.8 hr; p = 0.018 and 17.2 vs 83.8 hr; p = 0.033) in the iEEG group than in the control group. Favorable outcomes (GOS 4-5) were more frequently achieved in the iEEG group than in the control group (58% vs 31%; p = 0.065). No significant differences were detected in long-term mortality or post-traumatic epilepsy.
Invasive subdural electroencephalogram monitoring is valuable and safe for early seizure/SE detection and treatment and might improve outcomes in the neurocritical care of patients with aSDH.
癫痫发作和癫痫持续状态（SE）是急性硬膜下血肿（aSDH）的常见并发症，与发病率和死亡率增加有关。因此，我们旨在评估颅内硬膜下脑电图记录是否能更早地发现和治疗 aSDH 患者的癫痫发作。
前瞻性、单中心、队列试验。
德国一家学术医院的神经科和神经外科重症监护病房。
接受手术治疗的 aSDH 患者。这项研究共纳入了 76 名患者，其中 31 名患者（40.8%）被分配到有创脑电图（iEEG）监测组，45 名患者（59.2%）被分配到对照组。
电极组植入硬膜下条状电极，在神经重症监护病房提供长达 7 天的实时脑电图记录，而对照组在 7 天期间接受常规的常规脑电图。主要结局是癫痫发作和 SE 发生的发生率和时间。次要结局包括使用格拉斯哥预后量表（GOS）在出院和 6 个月随访时评估的神经功能结局，以及出院后 2 年内局灶性结构性癫痫的发生率。
在研究委员会会议上达到预定标准后，试验停止。iEEG 组和对照组在入院时的临床特征上匹配良好。iEEG 组的癫痫发作和 SE 检出率明显高于对照组（61%比 15.6%；p<0.001 和 38.7%比 11.1%；p=0.005）。iEEG 组的癫痫发作和 SE 检测时间明显更早（中位数 29.2 比 83.8 小时；p=0.018 和 17.2 比 83.8 小时；p=0.033）。iEEG 组的良好结局（GOS 4-5）比对照组更常见（58%比 31%；p=0.065）。两组在长期死亡率或外伤性癫痫方面无显著差异。
颅内硬膜下脑电图监测对于早期发现癫痫发作/SE 并进行治疗具有价值和安全性，可能改善 aSDH 患者神经重症监护的结局。
