Frequency and predictors of nonconvulsive seizures during continuous electroencephalographic monitoring in critically ill children
Frequency and predictors of nonconvulsive seizures during continuous electroencephalographic monitoring in critically ill children
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DOI：
10.1001/archneur.63.12.1750
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发表时间：
2006-12-01
影响因子：
--
通讯作者：
Hirsch, Lawrence J.
中科院分区：
文献类型：
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作者：
Jette, Nathalie;Claassen, Jan;Hirsch, Lawrence J.
目的：确定危重儿童连续脑电图监测 (cEEG) 期间非惊厥性癫痫发作 (NCSz) 的发生率、预测因素和时间。方法：我们确定了在 4 年期间接受 cEEG 的危重儿童。进行多变量逻辑回归分析以确定与 NCSz 相关的变量。结果：在 117 名受监测儿童中，44% 的 cEEG 出现癫痫发作，39% 患有 NCSz。大多数癫痫发作患者 (75%) 患有纯粹的 NCSz，23% 的患者患有癫痫持续状态，其中 89% 的病例纯粹是非惊厥。 15% 的人在开始 cEEG 后立即发生癫痫发作，50% 的人在 1 小时内发生癫痫发作，80% 的人在 24 小时内发生癫痫发作。那些在 cEEG 之前有临床癫痫发作的人比那些既往没有癫痫发作的人 (17%) 更有可能在 cEEG 上出现 NCSz (83%)。在多变量分析中，NCSz 与周期性侧向癫痫样放电和无背景反应性相关。结论：癫痫发作（大多数是 NCSz）在危重儿童 cEEG 期间很常见（44% 的患者出现）。一半在记录的第一个小时内被检测到，而 20% 直到记录超过 24 小时后才被检测到。非惊厥性癫痫发作与周期性偏侧癫痫样放电和 cEEG 缺乏反应性有关。这项研究证实了延长 cEEG 对于危重儿童作为检测 NCSz 的一种手段的重要性。
Objective: To determine the incidence, predictors, and timing of nonconvulsive seizures (NCSz) during continuous electroencephalographic monitoring (cEEG) in critically ill children.Methods: We identified critically ill children who underwent cEEG during a 4-year period. Multivariate logistic regression analysis was performed to determine variables associated with NCSz.Results: Among 117 monitored children, 44% had seizures on cEEG and 39% had NCSz. The majority of patients with seizures (75%) had purely NCSz, and 23% of patients had status epilepticus, which was purely nonconvulsive in 89% of cases. Seizures occurred immediately on cEEG initiation in 15%, within 1 hour in 50%, and within 24 hours in 80%. Those with clinical seizures prior to cEEG were more likely to have NCSz on cEEG (83%) than those without prior seizures (17%). On multivariate analysis, NCSz were associated with periodic lateralized epileptiform discharges and absence of background reactivity.Conclusions: Seizures, the majority being NCSz, are common during cEEG in critically ill children (seen in 44% of patients). Half are detected in the first hour of recording, whereas 20% are not detected until after more than 24 hours of recording. Nonconvulsive seizures are associated with periodic lateralized epileptiform discharges and absence of reactivity on cEEG. This study confirms the importance of prolonged cEEG for critically ill children as a means to detect NCSz.