Seizure burden in subarachnoid hemorrhage associated with functional and cognitive outcome
Seizure burden in subarachnoid hemorrhage associated with functional and cognitive outcome
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DOI：
10.1212/wnl.0000000000002281
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发表时间：
2016-01-19
期刊：
影响因子：
9.9
通讯作者：
Claassen, Jan
中科院分区：
文献类型：
--
作者：
De Marchis, Gian Marco;Pugin, Deborah;Claassen, Jan
目的：评估蛛网膜下腔出血（SAH）后3个月连续脑电图（cEEG）癫痫发作负荷与功能和认知结果之间的关系。方法：本研究纳入了1996年至2013年期间哥伦比亚大学医学中心神经重症监护室收治的所有连续自发性SAH患者，并进行了cEEG监测。癫痫发作负荷定义为cEEG上癫痫发作的持续时间（小时）。认知结果用电话访谈认知状态（TICS，范围从0到51，表示差到好的整体精神状态）进行测量。结果：总体而言，402例SAH患者的中位年龄为58岁（四分位距[IQR] 46-68岁）。cEEG监测的中位持续时间为96小时（IQR 48-155小时）。50例患者（12%）记录了癫痫发作，中位癫痫发作负荷为6小时（IQR 1-13小时）。在3个月时，在多变量分析中，癫痫发作负担与不利的功能和认知结果相关。cEEG上每小时癫痫发作与1.10的比值比相关（95%置信区间[CI] 1.01-1.21，p = 0.04）至3个月残疾和死亡，TICS评分平均下降0.16分（校正系数-0.19，95%CI-0.33 to-0.05，p = 0.01）。结论：在本研究中，在校正了已建立的预测因素后，癫痫发作负担与SAH后3个月的功能结局和认知障碍相关。
Objective:To assess the relationship between seizure burden on continuous EEG (cEEG) and functional as well as cognitive outcome 3 months after subarachnoid hemorrhage (SAH).Methods:The study included all consecutive patients with a spontaneous SAH admitted to the Columbia University Medical Center Neurological Intensive Care Unit and monitored with cEEG between 1996 and 2013. Seizure burden was defined as the duration, in hours, of seizures on cEEG. Cognitive outcomes were measured with the Telephone Interview for Cognitive Status (TICS, ranging from 0 to 51, indicating poor to good global mental status).Results:Overall, 402 patients with SAH were included with a median age of 58 years (interquartile range [IQR] 46-68 years). The median duration of cEEG monitoring was 96 hours (IQR 48-155 hours). Seizures were recorded in 50 patients (12%), in whom the median seizure burden was 6 hours (IQR 1-13 hours). At 3 months, in multivariate analysis, seizure burden was associated with unfavorable functional and cognitive outcome. Every hour of seizure on cEEG was associated with an odds ratio of 1.10 (95% confidence interval [CI] 1.01-1.21, p = 0.04) to 3-month disability and mortality, and the TICS-score decreased, on average, by 0.16 points (adjusted coefficient -0.19, 95% CI -0.33 to -0.05, p = 0.01).Conclusion:In this study, after adjusting for established predictors, seizure burden was associated with functional outcome and cognitive impairment 3 months after SAH.