Generalized periodic discharges in the critically ill

Abstract

Objective: Generalized periodic discharges are increasingly recognized on continuous EEG monitoring, but their relationship to seizures and prognosis remains unclear.Methods: All adults with generalized periodic discharges from 1996 to 2006 were matched 1:1 to controls by age, etiology, and level of consciousness. Overall, 200 patients with generalized periodic discharges were matched to 200 controls. Results:Mean age was 66 years (range 18-96); 56% were comatose. Presenting illnesses included acute brain injury (44%), acute systemic illness (38%), cardiac arrest (15%), and epilepsy (3%). A total of 46% of patients with generalized periodic discharges had a seizure during their hospital stay (almost half were focal), vs 34% of controls (p ϭ 0.014). Convulsive seizures were seen in a third of both groups. A total of 27% of patients with generalized periodic discharges had nonconvulsive seizures, vs 8% of controls (p Ͻ 0.001); 22% of patients with generalized periodic discharges had nonconvulsive status epilepticus, vs 7% of controls (p Ͻ 0.001). In both groups, approximately half died or were in a vegetative state, one-third had severe disability, and one-fifth had moderate to no disability. Excluding cardiac arrest patients, generalized periodic discharges were associated with increased mortality on univariate analysis (36.8% vs 26.9%; p ϭ 0.049). Multivariate predictors of worse outcome were cardiac arrest, coma, nonconvulsive status epilepticus, and sepsis, but not generalized periodic discharges. Conclusion:Generalized periodic discharges were strongly associated with nonconvulsive seizures and nonconvulsive status epilepticus. While nonconvulsive status epilepticus was independently associated with worse outcome, generalized periodic discharges were not after matching for age, etiology, and level of consciousness. Neurology ® 2012; 79:1951-1960

Electroencephalographic Patterns Recorded by Continuous EEG Monitoring in Patients with Change of Consciousness in the Neurological Intensive Care Unit

“…In a study of 200 patients with GPED, it was ascertained that the most common etiologies found through cEEG monitoring were toxic-metabolic encephalopathy, septicemia, and stroke and that GPED was associated with the high incidence of NCS-NCSE (20). Similar to this study, the presence of NCS-NCSE showed significantly high association with GPED in our study.…”

“…Some studies suggested that the use of wave morphology and/or response to intravenous benzodiazepine could help in diagnosis (20). In our study, the presence of metabolic disorder (specifically electrolyte disturbance) was significantly high in the patients with GPED having TW morphology.…”

“…Some retrospective studies speculated that this association could be due to hormonal, genetic, and epidemiological factors, but there is a need for further studies to clarify this issue (20).…”

Role of Routine Benzodiazepin in Eliciting Classical Electroencephalogram (EEG) Response in Suspected Sub-Acute Sclerosing Panencephalitis (SSPE) Cases

“…The normal EEG, atypical PSWC or other EEG findings were converted to typical PSWC in most cases. The difference between the two drugs was not statistically significantly different [11]. In fact, for the respiratory side effects, midazolam is preferred to diazepam in certain conditions [7].…”

“…Although we had good enough samples in the particular time, larger samples could make the results different. One study administered both the drugs in same person in consecutive days [11]. It would be better if we could do so.…”