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首页> 外文期刊>JAMA neurology >Similarity of lateralized rhythmic delta activity to periodic lateralized epileptiform discharges in critically ill patients
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Similarity of lateralized rhythmic delta activity to periodic lateralized epileptiform discharges in critically ill patients

机译：重症患者周期性节律性三角洲活动与周期性癫痫样放电的相似性

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Importance The increasing use of continuous electroencephalography (EEG) monitoring in the intensive care unit has led to recognition of new EEG patterns that are of unclear or unknown significance. Objective To describe an EEG pattern, lateralized rhythmic delta activity (LRDA), encountered in critically ill subjects and determine its clinical significance in this setting. Design, Setting, and Participants Retrospective review at an academic medical center of EEG recordings, medical records, and imaging studies of critically ill patients with LRDA and comparison with subjects with lateralized periodic discharges (also known as periodic lateralized epileptiform discharges), subjects with focal nonrhythmic slowing, and controls. INTERVENTION Electroencephalography or continuous electroencephalography. Main Outcomes and Measures Cross-sectional prevalence of lateralized rhythmic delta activity; EEG characteristics; etiology, clinical, and radiological correlates; and risk of early seizures. Results We identified LRDA in 4.7%of acutely ill subjects undergoing EEG or continuous EEG monitoring. It was often associated with other focal EEG abnormalities, including lateralized periodic discharges in 44%of cases. The most common conditions associated with LRDA were intracranial hemorrhage and subarachnoid hemorrhage. Lateralized rhythmic delta activity was an independent predictor of acute seizures, with 63%of subjects having seizures during their acute illness, a proportion similar to subjects with lateralized periodic discharges (57%) and significantly higher than associated with focal nonrhythmic slowing (20%) or in control subjects (16%). Most patients (80%-90%) in the LRDA and lateralized periodic discharges groups who had seizures while undergoing continuous EEG monitoring had only nonconvulsive seizures, whereas this was the case for only 17%of patients in the other groups. Lateralized rhythmic delta activity and lateralized periodic discharges were both associated with lesions involving the cortex or juxtacortical white matter. Conclusions and Relevance Lateralized rhythmic delta activity in critically ill patients has a similar clinical significance as lateralized periodic discharges. It reflects the presence of a focal lesion and is associated with a high risk of acute seizures, especially nonconvulsive.
机译：重要性重症监护病房不断使用连续脑电图（EEG）监测已导致人们认识到意义不明或未知的新EEG模式。目的描述危重患者的脑电图模式，侧律性律动活动（LRDA），并确定其在这种情况下的临床意义。设计，设置和参与者在学术机构的脑电图记录，病历和影像学研究的回顾性研究中，对重度LRDA的重症患者进行检查，并与侧偏周期性放电（也称为周期性偏癫痫样放电），局灶性受试者进行比较非节律性减慢和控制。干预脑电图或连续脑电图。主要结果和措施侧律性三角洲活动的横断面患病率;脑电特征;病因，临床和放射学相关;和早期发作的风险。结果我们在接受脑电图或连续脑电图监测的4.7％急性病患者中确定了LRDA。它通常与其他局灶性脑电图异常有关，包括44％的病例出现周期性的周期性放电。与LRDA相关的最常见疾病是颅内出血和蛛网膜下腔出血。节律性三角洲活动水平是急性癫痫发作的独立预测指标，其中63％的受试者在急性疾病期间发作，这一比例与周期性发作的受试者（57％）相似，并且显着高于局部非节律性减慢（20％）或对照组（16％）。 LRDA和周期性定期出院的患者中，大多数患者（80％-90％）在连续进行EEG监测的同时出现癫痫发作，只有非惊厥性癫痫发作，而其他组中只有17％的患者属于这种情况。侧向节律性δ活动和侧向周期性放电均与涉及皮层或近皮质白质的病变有关。结论和相关性危重患者的节律性δ活动偏侧化与定期放电的偏侧具有相似的临床意义。它反映了局灶性病变的存在，并伴有急性发作，尤其是非惊厥发作的高风险。

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