Clinical outcome of generalized periodic epileptiform discharges on first EEG in patients with hypoxic encephalopathy postcardiac arrest
Clinical outcome of generalized periodic epileptiform discharges on first EEG in patients with hypoxic encephalopathy postcardiac arrest
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DOI：
10.1016/j.yebeh.2015.06.010
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发表时间：
2015-08-01
影响因子：
2.6
通讯作者：
Brunnhuber, F.
中科院分区：
文献类型：
--
作者：
Ribeiro, A.;Singh, R.;Brunnhuber, F.
脑电图与临床检查、影像学检查和ssep一起用于确定心脏骤停后缺氧脑病的预后。广泛性周期性癫痫样放电（gped）被认为是一种“恶性”脑电图模式，预后非常差，以前的研究报告没有或很少有幸存者。我们查看了随后发展为gped的心脏骤停患者的数据库，以确定临床结果并分析任何幸存者。thodoloa：我们确定了2011-2014年间在国王学院医院接受治疗的所有心脏骤停患者，这些患者发生了与gped、双侧周期性癫痫样放电（双侧周期性癫痫样放电）和首次脑电图周期性放电相关的缺氧性脑病。我们收集了临床数据，包括年龄、性别、停药时间、脑电图反应性、癫痫发作或肌阵挛的存在以及结果。幸存者定义为出院回家或神经康复病房的患者。结果：36例心肌骤停后伴有缺氧脑病的患者，24/36例为gped， 12/36例为双pleds。患者平均年龄62.8 - 14.5岁，男性27例（75%），女性9例（25%）。36例患者中有10例存活，略高于先前报道。比较幸存者和非幸存者临床特征的统计检验显示，除了首次脑电图出现反应性的趋势具有显著性外，没有显著差异（p = 0.0794）。出院时，一名幸存者有良好的功能结果，随后变得独立，但所有其他幸存者都依赖所有adl（日常生活活动）。结论：心脏骤停后全身性周期性癫痫样放电具有严重的临床预后。与以前的研究相比，这项研究确实确定了更多的幸存者，但大多数人在出院时严重残疾。第一次脑电图的反应性可能预示着更好的预后，值得进一步评估。爱思唯尔2015年版权所有版权所有
Introduction: The EEG, alongside clinical examination, imaging studies, and SSEPs, is used to determine the prognosis following hypoxic encephalopathy postcardiac arrest. Generalized periodic epileptiform discharges (GPEDs) are recognized as a "malignant" EEG pattern associated with very poor outcome with previous studies reporting no or few survivors. We looked at our database of cardiac arrest patients who subsequently developed GPEDs to determine clinical outcome and profile any survivors. thodoloa: We identified all cardiac arrest patients treated at King's College Hospital between 2011-2014 who developed hypoxic encephalopathy associated with GPEDs, BiPLEDs (bilateral periodic lateralized epileptiform discharges), and periodic discharges on first EEG. We collected clinical data including age, gender, downtime, EEG reactivity, presence of seizures or myoclonus, and outcome. Survivors were defined as patients who were discharged from the hospital to home or a neurorehabilitation unit.Results.: Thirty-six postcarcliac arrest patients with hypoxic encephalopathy were identified, 24/36 with GPEDs, and 12/36 with BiPLEDs on first EEG. The mean age of patients was 62.8 14.5 years old, with 27 males (75%) and 9 females (25%). Ten of thirty-six patients survived, which is slightly higher than previously reported. Statistical tests to compare clinical characteristics between survivors and nonsurvivors demonstrated no significant differences except for trend to significance for the presence of reactivity on first EEG (p 0.0794). On discharge, one survivor had good functional outcome and subsequently became independent), but all others were dependent for all ADLs (activities of daily living).Conclusion: Generalized periodic epileptiform discharges carry a grave clinical prognosis following cardiac arrest. This study did identify a higher number of survivors compared to previous studies, but most were severely disabled at hospital discharge. Reactivity of the first EEG might predict better prognosis and merit further evaluation. Crown Copyright (C) 2015 Published by Elsevier Inc. All rights reserved