Emergent EEG in clinical practice
Emergent EEG in clinical practice
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DOI：
10.1016/j.clinph.2007.07.003
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发表时间：
2007-10-01
影响因子：
4.7
通讯作者：
De Toffol, Bertrand
中科院分区：
文献类型：
--
作者：
Praline, Julien;Grujic, Jelena;De Toffol, Bertrand
目的：紧急情况需要快速准确的诊断方法。然而，脑电图（EEG）在紧急情况下的确切作用和价值尚未明确定义。我们的目标是确定为什么临床医生为了紧急脑电图，以评估在何种程度上有助于建立一个正确的诊断，并评估其结果对随后的病人management.Methods：我们研究了所有连续的紧急脑电图订购在3个月内，在我们的机构。我们分析了为什么每个脑电图订购的原因，并采访了开处方的临床医生，以确定EEG的结果对诊断和随后的治疗management.Results的影响：我们前瞻性地研究了共111个连续的录音。急诊脑电图检查的主要原因为：疑似脑死亡（21%）、非惊厥性癫痫持续状态（19.71/，）、轻微癫痫持续状态（14%）和惊厥性癫痫持续状态随访（11.2%）。在77.5%的病例中，临床医生认为EEG有助于做出诊断，并在36%的病例中帮助确认临床疑似诊断。当怀疑为轻微癫痫持续状态（SSE）或非惊厥性癫痫持续状态（NCSE）时，分别有45%和43.3%的病例确诊。在22.2%涉及初始治疗后惊厥性癫痫持续状态随访的请求中，EEG显示持续性癫痫持续状态。在所有病例中，37.8%的患者治疗发生变化。当EEG帮助建立诊断，病人的治疗随后修改在46.6%的cases.Conclusions：这项前瞻性研究证实了紧急EEG在某些特定的临床背景下的价值：惊厥性癫痫持续状态的管理初始治疗后或排除微妙的癫痫持续状态。紧急脑电图也可以责令如果一个怀疑存在非惊厥性癫痫持续状态时，病人提出精神混乱或改变清醒后，第一次寻找具体的迹象表明这一诊断hypothes.Significance的存在：经过50年的发展和使用在日常实践中，脑电图仍然是一个可靠的，廉价和有用的诊断工具，在一些明确定义的紧急情况。(C)2007年国际临床神经生理学联合会。由Elsevier爱尔兰有限公司出版。保留所有权利。
Objective: Emergency situations require a rapid and precise diagnostic approach. However, the exact role and value of the electroencephalogram (EEG) in emergent conditions have yet to be clearly defined. Our objective was to determine why clinicians order an emergency EEG, to assess to what extent it helps establish a correct diagnosis and to evaluate the result it has on subsequent patient management.Methods: We studied all successive emergency EEGs ordered during a 3-month period in our institution. We analyzed the reasons why each EEG was ordered and interviewed the prescribing clinicians in order to determine the impact the result of the EEG had on the diagnosis and subsequent therapeutic management.Results: We prospectively studied a total of 111 consecutive recordings. The main reasons for ordering an emergent EEG were: suspected cerebral death (21%), non-convulsive status epilepticus (19.71/,,), subtle status epilepticus (14%) and follow-up of convulsive status epilepticus (11.2%). In 77.5%, of the cases the clinicians considered that the EEG contributed to making the diagnosis and that it helped confirm a clinically-suspected diagnosis in 36% of the cases. When subtle status epilepticus (SSE) or non-convulsive status epilepticus (NCSE) was suspected, the diagnosis was confirmed in 45% and 43.3% of the cases, respectively. In 22.2% of the requests involving follow-up of convulsive status epilepticus after initial treatment, the EEG demonstrated persistent status epilepticus. It resulted in a change in patient treatment in 37.8% of all the cases. When the EEG helped establish the diagnosis, patient treatment was subsequently modified in 46.6% of the cases.Conclusions: This prospective study confirms the value of an emergent EEG in certain specific clinical contexts: the management of convulsive status epilepticus following initial treatment or to rule out subtle status epilepticus. An emergent EEG can also be ordered if one suspects the existence of non-convulsive status epilepticus when a patient presents with mental confusion or altered wakefulness after first looking for the specific signs suggesting this diagnostic hypothesis.Significance: After 50 years of development and use in daily practice, the EEG remains a dependable, inexpensive and useful diagnostic tool in a number of clearly-defined emergency situations. (C) 2007 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.