Narrett Jackson A, Byrnes MarieElena, Gilmore Emily J, Hirsch Lawrence J, Punia Vineet, Sivaraju Adithya
Yale New Haven Hospital.
Cleveland Clinic Health System: Cleveland Clinic.
Res Sq. 2024 Oct 14:rs.3.rs-4649424. doi: 10.21203/rs.3.rs-4649424/v1.
Increasing use of continuous EEG monitoring (cEEG) provides the opportunity to observe temporal trends in EEG patterns during the acute phase of brain injury. These trends have not been extensively documented.
We conducted a retrospective chart review of patients undergoing cEEG between January 1st and June 30th, 2019, at two academic medical centers. Only patients with acute brain injury having electrographic or electroclinical seizures or epileptic EEG findings on day one of monitoring and ≥ two calendar days of cEEG were included. The temporal evolution of EEG patterns was depicted as a heatmap.
Of 1356 screened patients, 101 met the study criteria. Clinical acute symptomatic seizures occurred in 30 patients (29.7%) prior to EEG. The median number of days of cEEG was four (IQR 3-6). Amongst patients with electrographic seizures, status epilepticus, generalized periodic discharges, or sporadic epileptiform discharges, 24.6% had improvement and 54.1% had resolution of epileptic EEG findings by the final day of monitoring. In contrast, 65% with lateralized periodic discharges or lateralized rhythmic delta activity persisted or worsened. Overall, 61.4% (62/101) showed either improvement (19.8%) or resolution (41.6%) of their EEG findings prior to hospital discharge. Of the 36 patients with follow-up EEGs at a median of 4.5 (IQR 3-8) months after admission for acute brain injury, 83% (30/36) showed either improvement (1/36; 2.7%) or resolution (29/36; 80.6%).
We observed a trend towards normalization of most epileptiform patterns except LPDs and LRDA, over time in patients with acute brain injury. The clinical significance of this trend as it relates to antiseizure medication treatment and neurologic outcomes warrants further investigation in an independent cohort.
持续脑电图监测（cEEG）的使用日益增加，这为观察脑损伤急性期脑电图模式的时间趋势提供了机会。这些趋势尚未得到广泛记录。
我们对2019年1月1日至6月30日期间在两个学术医学中心接受cEEG监测的患者进行了回顾性病历审查。仅纳入在监测第一天有脑电图或电临床发作或癫痫性脑电图表现且cEEG监测≥两个日历日的急性脑损伤患者。脑电图模式的时间演变以热图表示。
在1356例筛查患者中，101例符合研究标准。30例患者（29.7%）在脑电图检查前出现临床急性症状性发作。cEEG的中位天数为4天（四分位间距3 - 6天）。在有脑电图发作、癫痫持续状态、全身性周期性放电或散发性癫痫样放电的患者中，24.6%的患者病情有所改善，54.1%的患者在监测最后一天癫痫性脑电图表现消失。相比之下，有侧化周期性放电或侧化节律性δ活动的患者中，65%的患者病情持续或恶化。总体而言，61.4%（62/101）的患者在出院前脑电图表现有所改善（19.8%）或消失（41.6%）。在急性脑损伤入院后中位时间为4.5个月（四分位间距3 - 8个月）进行随访脑电图检查的36例患者中，83%（30/36）的患者脑电图表现有所改善（1/36；2.7%）或消失（29/36；80.6%）。
我们观察到，除侧化周期性放电和侧化节律性δ活动外，急性脑损伤患者的大多数癫痫样模式随时间有趋于正常化的趋势。这种趋势与抗癫痫药物治疗和神经学预后的临床意义值得在独立队列中进一步研究。
