EEG DETECTION OF NONTONIC-CLONIC STATUS EPILEPTICUS IN PATIENTS WITH ALTERED CONSCIOUSNESS
EEG DETECTION OF NONTONIC-CLONIC STATUS EPILEPTICUS IN PATIENTS WITH ALTERED CONSCIOUSNESS
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DOI：
10.1016/0920-1211(94)90008-6
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发表时间：
1994-06-01
影响因子：
2.2
通讯作者：
JESTER, D
中科院分区：
文献类型：
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作者：
PRIVITERA, M;HOFFMAN, M;JESTER, D
无强直-阵挛性惊厥（非强直-阵挛性SE）的癫痫持续状态（SE）亚型表现为意识改变，有时伴有细微的运动活动，这是鉴别诊断不明原因意识改变患者时需要考虑的重要因素。其他患者可能在脑电图（EEG）上表现为意识改变，伴有间歇性发作活动，这可能代表SE，但有其他医学条件可能导致意识改变。脑电图是诊断非强直-阵挛性脑电图的唯一可靠方法，我们在我院提供24小时急诊脑电图。为了确定脑电图检测到明确的或可能的非强直-阵挛性脑电图的频率，我们前瞻性地收集了医生要求脑电图评估意识改变或可能的脑电图的所有病例的数据。在198例意识改变但无临床惊厥的病例中，74例（37%）显示脑电图和临床证据明确或可能是非强直-阵挛性SE。42例（57%）为可能或明确的复杂部分性SE， 29例（39%）为可能或明确的轻度全身性SE， 3例（4%）为肌阵挛性SE。在23例SE病例中，意识改变是诊断时唯一的临床体征；另外36人有轻微的运动活动。临床症状和既往病史均不能预测哪些患者脑电图显示SE。非强直-阵挛性SE伴脑梗死16例。与其他报道相反，我们发现SE持续时间与脑电图模式之间没有关系。细微的广泛性SE最常见于弥漫性脑损伤，而不是由惊厥性SE演变而来。本研究表明，非强直-阵挛性SE在不明原因的意识改变患者中很常见，脑电图在评估这些患者时是必要的。
Subtypes of status epilepticus (SE) without tonic-clonic convulsions (nontonic-clonic SE) present as altered consciousness sometimes with subtle motor activity and are important to consider in the differential diagnosis of patients with unexplained altered consciousness. Other patients may have altered consciousness with intermittent ictal activity on electroencephalography (EEG) that represents probable SE, but have other medical conditions that may be contributing to altered consciousness. EEG is the only reliable way to make the diagnosis of nontonic-clonic SE and we make emergency EEG available on a 24-h basis at our hospital. To determine how often definite or probable nontonic-clonic SE was detected by EEG we prospectively collected data on all cases where physicians ordered EEG to evaluate altered consciousness or possible SE. Out of 198 cases with altered consciousness but no clinical convulsions, 74 (37%) showed EEG and clinical evidence of definite or probable nontonic-clonic SE. Forty-two episodes (57%) were probable or definite complex partial SE, 29 (39%) were probable or definite subtle generalized SE, and three (4%) were myoclonic SE. In 23 SE cases altered consciousness was the only clinical sign at the time of diagnosis; subtle motor activity was present in 36 others. Neither clinical signs nor prior history predicted which patients showed SE on EEG. Nontonic-clonic SE followed a cerebral infarction in 16 cases. Contrary to other reports, we found no relationship between duration of SE and EEG pattern. Subtle generalized SE occurred most commonly in the setting of a diffuse brain injury rather than evolving from convulsive SE, This study demonstrates that nontonic-clonic SE is a common finding in patients with unexplained altered consciousness and EEG is necessary in the evaluation of these patients.