Generalized periodic discharges in the critically ill A case-control study of 200 patients

被引:130
作者
Foreman, Brandon [1 ]
Claassen, Jan [2 ]
Abou Khaled, Karine [3 ]
Jirsch, Jeffrey [4 ]
Alschuler, Daniel M. [5 ]
Wittman, John [6 ]
Emerson, Ronald G. [7 ]
Hirsch, Lawrence J. [8 ]
机构
[1] Columbia Univ, Neurol Inst New York, Comprehens Epilepsy Ctr, New York, NY 10027 USA
[2] Columbia Univ, Neurol Inst New York, Div Crit Care Neurol, New York, NY USA
[3] Univ St Joseph, Hotel Dieu France, Paris, France
[4] Univ Alberta, Dept Med, Div Neurol, Edmonton, AB, Canada
[5] New York State Psychiat Inst & Hosp, Cognit Neurosci Div, New York, NY 10032 USA
[6] Neurol Associates Inc, Henrico, VA USA
[7] Hosp Special Surg, New York, NY 10021 USA
[8] Yale Univ, Sch Med, Div Epilepsy EEG, New Haven, CT USA
关键词
INTENSIVE-CARE-UNIT; NONCONVULSIVE STATUS EPILEPTICUS; CONVULSIVE STATUS EPILEPTICUS; EEG PATTERNS; ELECTROGRAPHIC SEIZURES; CLINICAL-FEATURES; PROGNOSIS; CLASSIFICATION; HEMORRHAGE;
D O I
10.1212/WNL.0b013e3182735cd7
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: Generalized periodic discharges are increasingly recognized on continuous EEG monitoring, but their relationship to seizures and prognosis remains unclear. Methods: All adults with generalized periodic discharges from 1996 to 2006 were matched 1: 1 to controls by age, etiology, and level of consciousness. Overall, 200 patients with generalized periodic discharges were matched to 200 controls. Results: Mean age was 66 years (range 18-96); 56% were comatose. Presenting illnesses included acute brain injury (44%), acute systemic illness (38%), cardiac arrest (15%), and epilepsy (3%). A total of 46% of patients with generalized periodic discharges had a seizure during their hospital stay (almost half were focal), vs 34% of controls (p = 0.014). Convulsive seizures were seen in a third of both groups. A total of 27% of patients with generalized periodic discharges had nonconvulsive seizures, vs 8% of controls (p < 0.001); 22% of patients with generalized periodic discharges had nonconvulsive status epilepticus, vs 7% of controls (p < 0.001). In both groups, approximately half died or were in a vegetative state, one-third had severe disability, and one-fifth had moderate to no disability. Excluding cardiac arrest patients, generalized periodic discharges were associated with increased mortality on univariate analysis (36.8% vs 26.9%; p = 0.049). Multivariate predictors of worse outcome were cardiac arrest, coma, nonconvulsive status epilepticus, and sepsis, but not generalized periodic discharges. Conclusion: Generalized periodic discharges were strongly associated with nonconvulsive seizures and nonconvulsive status epilepticus. While nonconvulsive status epilepticus was independently associated with worse outcome, generalized periodic discharges were not after matching for age, etiology, and level of consciousness. Neurology (R) 2012;79:1951-1960
引用
收藏
页码:1951 / 1960
页数:10
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