Matthews Alexander J, Starkie Fiona E, Staniaszek Lydia E, Kane Nicholas M
Neurophysiology Department, University Hospitals Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8BJ, UK.
Bristol Haematology and Oncology Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Horfield Road, Bristol, BS2 8ED, UK.
Clin EEG Neurosci. 2025 Nov;56(6):540-548. doi: 10.1177/15500594241312451. Epub 2025 Jan 8.
Neurotoxicity, encephalopathy, and seizures can occur following chimeric antigen receptor (CAR)-T cell therapy. Our aim was to assess what value electroencephalography (EEG) offers for people undergoing CAR-T treatment in clinical practice, including possible diagnostic, management, and prognostic roles. All patients developing CAR-T related neurotoxicity referred for EEG were eligible for inclusion. Reasons for EEG referral and qualitative EEG findings were analysed and reported. The relationship between objective quantitative EEG (QEEG) encephalopathy grade and clinical neurotoxicity (immune effector cell-associated neurotoxicity syndrome; ICANS) grade was determined. The prognostic ability of QEEG grade was assessed for survival and functional status. Twenty-eight patients with 53 EEG recordings were included. Common reasons given on EEG referrals were possible seizure diagnosis (n = 38), reduced consciousness (n = 8), and superimposed cerebral infection (n = 4). Four focal seizures were detected on three (3/53; 5.7%) EEGs. There was a moderately positive correlation between QEEG grade and ICANS grade (r = + 0.41, p = .030). QEEG grade could not predict survival at 3 months (Area Under Curve; AUC = 0.673) or 6 months (AUC = 0.578), nor could it predict functional status at 1 month (r = + 0.40; p = .080), 3 months (r = + 0.19; p = .439), or time to return to baseline (r = + 0.32; p = .156). EEG was useful in seizure diagnosis. QEEG has a possible role as a specific biomarker of encephalopathy/neurotoxicity. EEG generated no tangible changes in patient management. QEEG was unable to prognosticate survival or functional status.
嵌合抗原受体（CAR）-T细胞治疗后可能会发生神经毒性、脑病和癫痫发作。我们的目的是评估脑电图（EEG）在临床实践中对接受CAR-T治疗的患者有何价值，包括可能的诊断、管理和预后作用。所有因CAR-T相关神经毒性而接受EEG检查的患者均符合纳入标准。分析并报告了EEG检查的转诊原因和定性EEG结果。确定了客观定量脑电图（QEEG）脑病分级与临床神经毒性（免疫效应细胞相关神经毒性综合征；ICANS）分级之间的关系。评估了QEEG分级对生存和功能状态的预后能力。纳入了28例患者的53次EEG记录。EEG转诊的常见原因包括可能的癫痫诊断（n = 38）、意识减退（n = 8）和叠加性脑感染（n = 4）。在53次EEG中的3次（3/53；5.7%）检测到4次局灶性癫痫发作。QEEG分级与ICANS分级之间存在中度正相关（r = +0.41，p = 0.030）。QEEG分级无法预测3个月（曲线下面积；AUC = 0.673）或6个月（AUC = 0.578）时的生存率，也无法预测1个月（r = +0.40；p = 0.080）、3个月（r = +0.19；p = 0.439）时的功能状态或恢复至基线的时间（r = +0.32；p = 0.156）。EEG对癫痫诊断有用。QEEG可能作为脑病/神经毒性的特异性生物标志物发挥作用。EEG未对患者管理产生切实改变。QEEG无法对生存或功能状态进行预后评估。
