Electrographic and Clinical Natural History of Lateralized Periodic Discharges

Punia, Vineet; Vakani, Ravi; Burgess, Richard C.; Hantus, Stephen

doi:10.1097/wnp.0000000000000428

Cited by 15 publications

(21 citation statements)

References 20 publications

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“…Interestingly in our study, more than 1.5 years after being discharged on AED, two‐thirds (65.7%) of cases were still taking at least one AED. Similar trends have been noted previously as well . AEDs status at discharge was not used in statistical modeling because it was found to be highly collinear with the group status (95% of cases were on AEDs at discharge as compared to only 16% of controls).…”

Section: Discussionsupporting

confidence: 55%

“…Previously, we have investigated the development of new‐onset epilepsy after patients were found to have electrographic seizures (NCS/NCSE), LPDs, or generalized periodic discharges (GPDs) on cEEG. In these retrospective, medical records review‐based studies, we have shown that the risk of epilepsy development is determined by the type of cEEG findings . Building on this work, we designed a matched, parallel cohort study with the specific aims of finding the impact of highly epileptic cEEG features – that is, electrographic seizures and LPDs – on the risk of epilepsy development after acute hospitalization.…”

Section: Introductionmentioning

confidence: 99%

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Electroencephalographic biomarkers of epilepsy development in patients with acute brain injury: a matched, parallel cohort study

Punia

Fitzgerald

Zhang

et al. 2019

Ann Clin Transl Neurol

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ObjectiveThis study was designed to investigate if highly epileptic electroencephalogram (EEG) findings in patients with acute brain injury increase the long‐term risk of epilepsy development.MethodsAdults patients, lacking epilepsy history, with electrographic seizures or lateralized periodic discharges (LPDs) (cases) were identified and matched based on age, mental status, and etiology with the ones lacking any epileptiform activity (controls) on continuous EEG (cEEG) during hospitalization. The primary outcome of clinical seizures after hospital discharge and their antiepileptic drug (AED) status was determined using a telephonic interview. Logistic regression models using generalized estimating equations to account for the matched nature of the data were performed.ResultsA total of 70 cases [16 (22.9%) “LPDs only,” 34 (48.6%) “electrographic seizure only,” and 20 (28.6%) “both”] and controls were enrolled. A total of 22 (31.4%) cases developed epilepsy after a mean follow‐up duration of 20.6 ± 5.0 months compared to three (4.3%) controls. After adjusting for cEEG indication and follow‐up duration, the odds of cases developing epilepsy were almost 15 times higher compared to the controls (OR = 14.8, 95% CI = 2.4–92.3, P = 0.004). This elevated risk was despite a 10 times higher likelihood of cases to be taking AEDs at the last follow‐up (OR = 10.34, 95% CI = 3.7–29, P < 0.001).InterpretationHighly epileptic EEG findings in patients with acute brain injury may serve as prognostic biomarkers of epilepsy development. Although prospective studies are required to confirm our findings, it seems that with epilepsy developing in almost one‐third cases in less than 2‐year follow‐up period, such patients may potentially be ideal candidates for epilepsy prevention clinical trials.

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Section: Discussionsupporting

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Electroencephalographic biomarkers of epilepsy development in patients with acute brain injury: a matched, parallel cohort study

Punia

Fitzgerald

Zhang

et al. 2019

Ann Clin Transl Neurol

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“…Interestingly, 30% of patients in the NP/NE group were discharged on AEDs as well. Previously, we found similar high rates of discharge on AEDs in a different study population where we tried to map the long‐term, electrographic natural history of LPDs . In that study as well, close to one‐third (31%) of patients with LPDs developed epilepsy during a mean follow‐up of 19.8 ± 9.9 months …”

Section: Discussionsupporting

confidence: 52%

“…predicting new onset epilepsy among patient with periodic patterns (LPDs or GPDs) on cEEG in a different study population where we tried to map the long-term, electrographic natural history of LPDs. 22 In that study as well, close to one-third (31%) of patients with LPDs developed epilepsy during a mean follow-up of 19.8 ± 9.9 months. 22 Several common traits for epileptogenesis across the etiological spectrum of symptomatic epilepsies are currently being recognized.…”

Section: T a B L E 4 Adjusted Analyses Formentioning

confidence: 69%

“…22 In that study as well, close to one-third (31%) of patients with LPDs developed epilepsy during a mean follow-up of 19.8 ± 9.9 months. 22 Several common traits for epileptogenesis across the etiological spectrum of symptomatic epilepsies are currently being recognized. 20 This is reflected in our study, as varied acute or progressive brain insults along with systemic encephalopathies led to common cEEG findings during acute illness and later epilepsy development.…”

Section: T a B L E 4 Adjusted Analyses Formentioning

confidence: 69%

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New onset epilepsy among patients with periodic discharges on continuous electroencephalographic monitoring

et al. 2018

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Patients with LPDs on cEEG during critical illness are at least seven times more likely to develop epilepsy compared to patients with NP/NE findings. This risk is further increased if patients with LPDs have electrographic seizures. In comparison, the presence of GPDs does not seem to impact the risk for developing epilepsy. cEEG findings at the time of acute insult have potential to serve as prognostic biomarkers for epilepsy development.

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Long‐term continuation of anti‐seizure medications after acute stroke

Punia

Honomichl

Chandan

et al. 2021

Ann Clin Transl Neurol

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Objective To investigate the factors associated with the long‐term continuation of anti‐seizure medications (ASMs) in acute stroke patients. Methods We performed a retrospective cohort study of stroke patients with concern for acute symptomatic seizures (ASySs) during hospitalization who subsequently visited the poststroke clinic. All patients had continuous EEG (cEEG) monitoring. We generated a multivariable logistic regression model to analyze the factors associated with the primary outcome of continued ASM use after the first poststroke clinic visit. Results A total of 507 patients (43.4% ischemic stroke, 35.7% intracerebral hemorrhage, and 20.9% aneurysmal subarachnoid hemorrhage) were included. Among them, 99 (19.5%) suffered from ASySs, 110 (21.7%) had epileptiform abnormalities (EAs) on cEEG, and 339 (66.9%) had neither. Of the 294 (58%) patients started on ASMs, 171 (33.7%) were discharged on them, and 156 (30.3% of the study population; 53.1% of patients started on ASMs) continued ASMs beyond the first poststroke clinic visit [49.7 (±31.7) days after cEEG]. After adjusting for demographical, stroke‐ and hospitalization‐related variables, the only independent factors associated with the primary outcome were admission to the NICU [Odds ratio (OR) 0.37 (95% CI 0.15–0.9)], the presence of ASySs [OR 20.31(95% CI 9.45–48.43)], and EAs on cEEG [OR 2.26 (95% CI 1.14–4.58)]. Interpretation Almost a third of patients with poststroke ASySs concerns may continue ASMs for the long term, including more than half started on them acutely. Admission to the NICU may lower the odds, and ASySs (convulsive or electrographic) and EAs on cEEG significantly increase the odds of long‐term ASM use.

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Electrographic and Clinical Natural History of Lateralized Periodic Discharges

Cited by 15 publications

References 20 publications

Electroencephalographic biomarkers of epilepsy development in patients with acute brain injury: a matched, parallel cohort study

Electroencephalographic biomarkers of epilepsy development in patients with acute brain injury: a matched, parallel cohort study

New onset epilepsy among patients with periodic discharges on continuous electroencephalographic monitoring

Long‐term continuation of anti‐seizure medications after acute stroke

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