Narrett Jackson A, Byrnes MarieElena, Gilmore Emily J, Hirsch Lawrence J, Punia Vineet, Sivaraju Adithya
Comprehensive Epilepsy Center, Department of Neurology, Yale New Haven Hospital, New Haven, CT, USA.
Epilepsy Center, Department of Neurology, Cleveland Clinic, Cleveland, OH, USA.
Neurocrit Care. 2025 Mar 4. doi: 10.1007/s12028-025-02227-y.
Increasing use of continuous electroencephalography (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 1 of monitoring and ≥ 2 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 4 (interquartile range 3-6 days). Among 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% of patients with lateralized periodic discharges or lateralized rhythmic delta activity persisted or worsened. Overall, 61.4% (62/101) of patients 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 (interquartile range 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%).
In patients with acute brain injury, we observed a trend over time toward the normalization of most epileptiform patterns, except for lateralized periodic discharges and lateralized rhythmic delta activity. 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（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疗中心接受cEEG检查的患者进行了回顾性病历审查。仅纳入在监测第1天有急性脑损伤且有脑电图或电临床癫痫发作或癫痫性脑电图表现且cEEG持续≥2个日历日的患者。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癫痫发作。cEEG的中位数天数为4天（四分位间距为3 - 6天）。在有脑电图癫痫发作、癫痫持续状态、广泛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，65%有局限性周期性放电或局限性节律性δ活动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36例急性脑损伤入院后中位时间为4.5个月（四分位间距为3 - 8个月）进行随访脑电图检查的患者中，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%）。
在急性脑损伤患者中，我们观察到随着时间的推移，除局限性周期性放电和局限性节律性δ活动外，大多数癫痫样模式有趋于正常化的趋势。这种趋势与抗癫痫药物治疗及神经学预后的临床意义值得在独立队列中进一步研究。
