Gupta Siddharth, Ritzl Eva K, Husari Khalil S
Comprehensive Epilepsy Center, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
J Clin Neurophysiol. 2025 Jan 1;42(1):44-50. doi: 10.1097/WNP.0000000000001064. Epub 2024 Jan 9.
To evaluate the clinical and electrographic characteristics of critically ill pediatric patients with lateralized rhythmic delta activity (LRDA) and compare them with patients with lateralized periodic discharges (LPDs).
This was a retrospective study examining consecutive critically ill pediatric patients (1 month-18 years) with LRDA or LPDs monitored on continuous electroencephalography. Clinical, radiologic, and electrographic characteristics; disease severity; and acute sequelae were compared between the two groups.
Of 668 pediatric patients monitored on continuous electroencephalography during the study period, 12 (1.79%) patients had LRDA and 15 (2.24%) had LPDs. The underlying etiologies were heterogeneous with no difference in the acuity of brain MRI changes between both groups. Lateralized rhythmic delta activity and LPDs were concordant with the side of MRI abnormality in most patients [85.7% (LRDA) and 83.3% (LPD)]. There was no difference in the measures of disease severity between both groups. Seizures were frequent in both groups (42% in the LRDA group and 73% in the LPD group). Patients in the LPD group had a trend toward requiring a greater number of antiseizure medications for seizure control (median of 4 vs. 2 in the LRDA group, p = 0.09), particularly those patients with LPDs qualifying as ictal-interictal continuum compared with those without ictal-interictal continuum ( p = 0.02).
Lateralized rhythmic delta activity and LPDs are uncommon EEG findings in the pediatric population. Seizures occur commonly in patients with these patterns. Seizures in patients with LPDs, especially those qualifying as ictal-interictal continuum, showed a trend toward being more refractory. Larger studies are needed in the future to further evaluate these findings.
评估患有侧化节律性δ活动（LRDA）的危重症儿科患者的临床和脑电图特征，并将其与患有侧化周期性放电（LPDs）的患者进行比较。
这是一项回顾性研究，检查在连续脑电图监测下患有LRDA或LPDs的连续危重症儿科患者（1个月至18岁）。比较两组患者的临床、放射学和脑电图特征；疾病严重程度；以及急性后遗症。
在研究期间接受连续脑电图监测的668例儿科患者中，12例（1.79%）有LRDA，15例（2.24%）有LPDs。潜在病因多种多样，两组间脑MRI改变的严重程度无差异。大多数患者（LRDA组为85.7%，LPD组为83.3%）的侧化节律性δ活动和LPDs与MRI异常的一侧一致。两组间疾病严重程度的测量指标无差异。两组癫痫发作均很常见（LRDA组为42%，LPD组为73%）。LPD组患者在控制癫痫发作时需要更多抗癫痫药物的趋势（中位数为4种，而LRDA组为2种，p = 0.09），特别是那些符合发作期-发作间期连续体的LPD患者与不符合发作期-发作间期连续体的患者相比（p = 0.02）。
侧化节律性δ活动和LPDs在儿科人群中是不常见的脑电图表现。有这些模式的患者常见癫痫发作。LPD患者的癫痫发作，尤其是那些符合发作期-发作间期连续体的患者，表现出更难控制的趋势。未来需要更大规模的研究来进一步评估这些发现。
