Effect of epileptiform abnormality burden on neurologic outcome and antiepileptic drug management after subarachnoid hemorrhage
Effect of epileptiform abnormality burden on neurologic outcome and antiepileptic drug management after subarachnoid hemorrhage
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DOI：
10.1016/j.clinph.2018.08.015
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发表时间：
2018-11-01
影响因子：
4.7
通讯作者：
Westover, M. Brandon
中科院分区：
文献类型：
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作者：
Zafar, Sahar F.;Postma, Eva N.;Westover, M. Brandon
目的：量化癫痫样异常（EAs）的负担，包括癫痫发作，周期性和节律性活动，和散发性放电在蛛网膜下腔出血（aSAH）患者，并评估EA负担和治疗对outcomes.Methods的影响：回顾性分析136例高级别aSAH患者。使用美国临床神经生理学学会命名法定义EA。负担定义为每个18-24小时时段的患病率> 90%。结果：47.8%的患者有EA。调整临床协变量后，记录第一天的EA负荷和最大日负荷与不良结局相关。具有较高EA负荷的患者更有可能在标准预防方案之外接受抗癫痫药物（AED）治疗。继续使用AED超过标准预防的患者与未使用标准预防的患者相比，结局无差异。结论：aSAH中EA的高负担独立预测了更差的结局。虽然近一半的患者接受治疗，我们的数据表明，目前的AED管理的做法可能不会影响outcome.Significance：EA负担预测更糟糕的结果，并可能作为一个目标，前瞻性干预对照研究，直接评估AED的影响，并创建循证治疗方案。(C)2018国际临床神经生理学联合会。Elsevier B. V.出版，保留所有权利。
Objective: To quantify the burden of epileptiform abnormalities (EAs) including seizures, periodic and rhythmic activity, and sporadic discharges in patients with aneurysmal subarachnoid hemorrhage (aSAH), and assess the effect of EA burden and treatment on outcomes.Methods: Retrospective analysis of 136 high-grade aSAH patients. EAs were defined using the American Clinical Neurophysiology Society nomenclature. Burden was defined as prevalence of 90% for each 18-24 hour epoch. Our outcome measure was 3-month Glasgow Outcome Score.Results: 47.8% patients had EAs. After adjusting for clinical covariates EA burden on first day of recording and maximum daily burden were associated with worse outcomes. Patients with higher EA burden were more likely to be treated with anti-epileptic drugs (AEDs) beyond the standard prophylactic protocol. There was no difference in outcomes between patients continued on AEDs beyond standard prophylaxis compared to those who were not.Conclusions: Higher burden of EAs in aSAH independently predicts worse outcome. Although nearly half of these patients received treatment, our data suggest current AED management practices may not influence outcome.Significance: EA burden predicts worse outcomes and may serve as a target for prospective interventional controlled studies to directly assess the impact of AEDs, and create evidence-based treatment protocols. (C) 2018 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.