Increased incidence and impact of nonconvulsive and convulsive seizures after traumatic brain injury as detected by continuous electroencephalographic monitoring
Increased incidence and impact of nonconvulsive and convulsive seizures after traumatic brain injury as detected by continuous electroencephalographic monitoring
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DOI：
10.3171/jns.1999.91.5.0750
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发表时间：
1999-11-01
影响因子：
4.1
通讯作者：
Becker, DP
中科院分区：
文献类型：
--
作者：
Vespa, PM;Nuwer, MR;Becker, DP
对象。在重症监护室（ICU）观察到的创伤性脑损伤的早期病理生理特征已经被描述为脑血流改变、脑代谢改变和神经化学兴奋毒性。癫痫发作发生在脑损伤动物模型和人类脑损伤。以前对人类创伤后癫痫发作的研究主要基于临床观察，没有系统的脑电图（EEG）记录癫痫发作。本研究的目的是通过对ICU患者损伤后最初14天的连续脑电图监测，前瞻性地确定惊厥性和非惊厥性癫痫发作的发生率。94例中重度颅脑损伤患者从入住ICU开始（平均延迟9.6±5.4小时）持续进行脑电图监测，并延长至损伤后14天。94例患者中有21例（22%）发生惊厥性和非惊厥性癫痫发作，其中6例表现为癫痫持续状态。超过一半的患者（52%）癫痫发作是非惊厥性的，仅根据脑电图诊断。6例癫痫持续状态患者全部死亡，而非癫痫发作组的死亡率为24%（73例中有18例）（p < 0.001）。癫痫持续状态患者的平均住院时间（9.14 +/- 5.9 d）较14 +/- 9 d短[t检验]。P < 0.03])。尽管在进入急诊室时开始使用预防性苯妥英，但仍发生癫痫发作，平均水平维持在16.6 +/- 2.8 mg/dl。在关键预后因素（如格拉斯哥昏迷量表评分、早期低氧血症、早期低血压或1个月格拉斯哥结局量表评分）中，癫痫发作患者与无癫痫发作患者无差异。癫痫发作发生在超过五分之一的患者在中重度脑损伤后的第一周，并可能在与脑损伤相关的病理生物学条件中发挥作用。
Object. The early pathophysiological features of traumatic brain injury observed in the intensive care unit (ICU) have been described in terms of altered cerebral blood flow, altered brain metabolism, and neurochemical excitotoxicity. Seizures occur in animal models of brain injury and in human brain injury. Previous studies of posttraumatic seizures in humans have been based principally on clinical observations without a systematic approach to electroencephalographic (EEG) recording of seizures. The purpose of this study was to determine prospectively the incidence of convulsive and nonconvulsive seizures by using continuous EEG monitoring in patients in the ICU during the initial 14 days postinjury.Methods. Ninety-four patients with moderate-to-severe brain injuries underwent continuous EEG monitoring beginning at admission to the ICU (mean delay 9.6 +/- 5.4 hours) and extending up to 14 days postinjury. Convulsive and non convulsive seizures occurred in 21 (22%) of the 94 patients, with six of them displaying status epilepticus. In more than half of the patients (52%) the seizures were nonconvulsive and were diagnosed on the basis of EEG studies alone. All six patients with status epilepticus died, compared with a mortality rate of 24% (18 of 73) in the nonseizure group (p < 0.001). The patients with Status epilepticus had a. shorter mean length of stay (9.14 +/- 5.9 days compared with 14 +/- 9 days [t-test. p < 0.03]). Seizures occurred despite initiation of prophylactic phenytoin on admission to the emergency room, with maintenance at mean levels of 16.6 +/- 2.8 mg/dl. No differences in key prognostic factors (such as the Glasgow Coma Scale score, early hypoxemia, early hypotension, or I-month Glasgow Outcome Scale score) were found between the patients with seizures and those without.Conclusions. Seizures occur in more than one in five patients during the 1st week after moderate-to-severe brain injury and may play a role in the pathobiological conditions associated with brain injury.