Characteristics and role in outcome prediction of continuous EEG after status epilepticus: A prospective observational cohort.
Characteristics and role in outcome prediction of continuous EEG after status epilepticus: A prospective observational cohort.
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作者：
Alvarez V;Drislane FW;Westover MB;Dworetzky BA;Lee JW
连续脑电图（cEEG）对于癫痫持续状态（SE）管理中的治疗指导非常重要，但其在临床结局预测中的作用尚不清楚。我们的目的是确定哪些cEEG特征在校正临床预测因子后提供独立的结果信息。使用2012年美国临床神经生理学学会的标准化重症监护EEG术语，在三个学术医学中心前瞻性收集了120例连续SE成人患者的cEEG数据。评估了cEEG特征与两个临床结局指标（死亡率和完全恢复）之间的相关性。在EEG记录的前24 h内，49例患者（40.8%）未显示周期性或节律性模式，45例（37.5%）有周期性放电，20例（16.7%）有节律性δ活动，6例（5%）有棘波放电。68.3%的患者记录了癫痫发作。在调整了已知的临床死亡率预测因素（包括癫痫状态严重程度评分（STESS）和潜在致命病因的存在）后，（在节律性和周期性模式、癫痫发作和背景活动中）仍然与结果显著相关的是缺乏后优势节律（比值比[OR] 9.8; p = 0.033）的死亡率和II期睡眠模式特征的变化（OR 2.59，这些类别中的每一步：无，存在和异常，存在和正常; p = 0.002）的完全恢复。在调整相关临床结果（包括SE严重程度和病因）后，cEEG背景信息（后优势节律和睡眠模式）比节律和周期性模式或癫痫发作更能预测SE后的临床结局。
Continuous electroencephalography (cEEG) is important for treatment guidance in status epilepticus (SE) management, but its role in clinical outcome prediction is unclear. Our aim is to determine which cEEG features give independent outcome information after correction for clinical predictor. cEEG data of 120 consecutive adult patients with SE were prospectively collected in three academic medical centers using the 2012 American Clinical Neurophysiology Society’s Standardized Critical Care EEG Terminology. Association between cEEG features and two clinical outcome measures (mortality and complete recovery) was assessed. In the first 24 h of EEG recording, 49 patients (40.8%) showed no periodic or rhythmic pattern, 45 (37.5%) had periodic discharges, 20 (16.7%) had rhythmic delta activity, and 6 (5%) had spike-and-wave discharges. Seizures were recorded in 68.3% of patients. After adjusting for known clinical predictive factors for mortality including the STatus Epilepticus Severity Score (STESS) and the presence of a potentially fatal etiology, the only EEG features (among rhythmic and periodic patterns, seizures, and background activity) that remained significantly associated with outcome were the absence of a posterior dominant rhythm (odds ratio [OR] 9.8; p = 0.033) for mortality and changes in stage II sleep pattern characteristics (OR 2.59 for each step up among these categories: absent, present and abnormal, present and normal; p = 0.002) for complete recovery. After adjustment for relevant clinical findings, including SE severity and etiology, cEEG background information (posterior dominant rhythm and sleep patterns) is more predictive for clinical outcome after SE than are rhythmic and periodic patterns or seizures.