Electrographic seizures and periodic discharges after intracerebral hemorrhage
Electrographic seizures and periodic discharges after intracerebral hemorrhage
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DOI：
10.1212/01.wnl.0000281664.02615.6c
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发表时间：
2007-09-25
期刊：
影响因子：
9.9
通讯作者：
Hirsch, L. J.
中科院分区：
文献类型：
--
作者：
Claassen, J.;Jette, N.;Hirsch, L. J.
目的：探讨脑出血(ICH)患者脑电及其他脑电表现的发生率和意义。方法：对102例脑出血患者进行连续脑电监测(CEEG)。记录人口学、临床、放射学和cEEG结果。应用多因素Logistic回归分析，我们确定了与1)脑电发作、2)周期性癫痫样放电(PED)和3)出院时预后不良(死亡、植物或最低意识状态)相关的因素。结果：31%(n=32)的脑出血患者在cEEG之前发生癫痫发作，其中19例发生在cEEG之前。18%(n=18)的患者有脑电发作；这些患者中只有一人在进行cEEG时也有临床癫痫发作。在控制了人口学和临床预测因素后，只有入院和24小时随访CT扫描期间脑出血量增加30%或更多与脑电发作相关(33%对15%；OR 9.5，95%CI 1.7至53.8)。出血部位距皮质至少1 mm者较少出现PED(8%比29%；OR 0.2，95%CI 0.1~0.7)。PED与不良预后独立相关(65%比17%；OR 7.6，95%CI 2.1~27.3)。在脑电监测的患者中，56%的患者在cEEG监测的第一小时内发现首次发作，94%的患者在48h内发现首次发作。结论：1/3的脑出血患者有癫痫发作，半数以上为纯脑电发作。脑电图性发作与扩大的出血、周期性放电、皮质脑出血和预后不良有关。需要进一步的研究来确定治疗或预防癫痫或儿科疾病是否可以改善脑出血后的预后。
Objective: To determine the frequency and significance of electrographic seizures and other EEG findings in patients with intracerebral hemorrhage (ICH).Methods: We reviewed 102 consecutive patients with ICH who underwent continuous electroencephalographic monitoring (cEEG). Demographic, clinical, radiographic, and cEEG findings were recorded. Using multivariate logistic regression analysis, we determined factors associated with 1) electrographic seizures, 2) periodic epileptiform discharges (PEDs), and 3) poor outcome (death, vegetative or minimally conscious state) at hospital discharge.Results: Seizures occurred in 31% (n = 32) of patients with ICH, prior to cEEG in 19 patients. Eighteen percent (n = 18) of patients had electrographic seizures; only one of these patients also had clinical seizures while on cEEG. After controlling for demographic and clinical predictors, only an increase in ICH volume of 30% or more between admission and 24-hour follow-up CT scan was associated with electrographic seizures (33% vs 15%; OR 9.5, 95% Cl 1.7 to 53.8). PEDs were less frequently seen in those with hemorrhages located at least 1 mm from the cortex (8% vs 29%; OR 0.2, 95% Cl 0.1 to 0.7). PEDs were independently associated with poor outcome (65% vs 17%; OR 7.6, 95% Cl 2.1 to 27.3). In patients with electrographic seizures, the first seizure was detected within the first hour of cEEG monitoring in 56% and within 48 hours in 94%.Conclusions: Seizures occurred in one third of patients with intracerebral hemorrhage (ICH) and over half were purely electrographic. Electrographic seizures were associated with expanding hemorrhages, and periodic discharges with cortical ICH and poor outcome. Further research is needed to determine if treating or preventing seizures or PEDs might lead to improved outcome after ICH.