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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2020; 78(06): 356-360
DOI: 10.1590/0004-282X20200026
Article

Presence of generalized periodic discharges and hospital mortality

Presença de descargas periódicas generalizadas e mortalidade hospitalar
Larissa MIYASHIRO 
1   Pontifícia Universidade Católica do Paraná, Hospital Universitário Cajuru, Curitiba, Paraná, Brazil.
,
Carolina OLIVEIRA DE PAULO 
1   Pontifícia Universidade Católica do Paraná, Hospital Universitário Cajuru, Curitiba, Paraná, Brazil.
,
Carlos Alexandre TWARDOWSCHY 
1   Pontifícia Universidade Católica do Paraná, Hospital Universitário Cajuru, Curitiba, Paraná, Brazil.
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ABSTRACT

Background: Generalized periodic discharges (GPDs) are rare patterns that can be found in long-term electroencephalographic monitoring in critical patients. These patterns have been correlated with non-seizure crisis and non-convulsive status epilepticus, associated with poor prognosis. Objective: To compare the outcome between patients who developed GPDs and patients with other abnormalities in long-term electroencephalographic monitoring. Methods: A retrospective study was performed by analyzing the medical records of 112 patients over 18 years who developed GPDs during long-term electroencephalographic monitoring (12–16 hours of monitoring) in the intensive care unit of a general hospital, compared with a group that had only nonspecific abnormalities in the monitoring. Results: Age and cardiorespiratory arrest (CA) were risk factors for death - OR 1.04 (95% CI 1,02 - 1,07) and p<0.001; OR 3.00 (95% CI 1,01 - 8,92) and p=0.046, respectively. It was not possible to evaluate if GPDs alone were associated with an unfavorable outcome or would be a bias for the development of CA in these patients. However, of the six isolated GPDs cases, 2/3 evolved to death, showing a tendency to worse prognosis. A significant difference (p=0.031) was observed for a worse outcome when comparing the group of 28 patients who presented GPD or CA with the other group which did not present any of these variables; of these 28 patients, 20 (71.4%) died. Conclusions: The presence of post-CA GPDs was associated with worse prognosis, but it was not clear whether these patterns are independent factors of an unfavorable evolution.

RESUMO

Introdução: As descargas periódicas generalizadas (DPG) são padrões raros que podem ser encontrados durante monitorização eletroencefalográfica prolongada (MEP) em pacientes críticos. Esses padrões têm sido correlacionados com crises não convulsivas e estado de mal epiléptico não convulsivo, associados a um pior prognóstico. Objetivo: Comparar o desfecho entre pacientes que desenvolveram DPG e pacientes com anormalidades inespecíficas na MEP. Métodos: Foi realizado um estudo retrospectivo através da análise dos prontuários de 112 pacientes acima de 18 anos que desenvolveram DPG durante MEP (de 12–16 horas de monitorização) na unidade de terapia intensiva de um hospital geral, comparando com um grupo que apresentou apenas anormalidades inespecíficas na MEP. Resultados: As variáveis idade e parada cardiorrespiratória (PCR) se mostraram como fatores de risco estatisticamente significativos para óbito - OR 1,04 (IC 95% 1,02 - 1,07) e p<0,001; OR 3,00 (IC 95% 1,01 - 8,92) e p=0,046, respectivamente. Não foi possível avaliar se DPG isoladamente se associaram a um desfecho desfavorável ou seriam um viés para o desenvolvimento de PCR nesses pacientes. Porém, dos seis casos de DPG isoladas, 2/3 evoluíram para óbito, o que revela uma tendência a pior prognóstico. Foi observada diferença significativa (p=0,031) para pior desfecho ao comparar o grupo de 28 pacientes que apresentou DPG ou PCR com o outro grupo que não apresentou nenhuma dessas variáveis, sendo que desses 28 pacientes, 20 (71,4%) foram a óbito. Conclusões: A presença de DPG pós-PCR está associada a pior prognóstico, porém não ficou claro se esses padrões são fatores independentes de evolução desfavorável.

Keywords:

Electroencephalography - Intensive Care Units - Encephalopathies - Hospital mortality

Palavras-chave:

Eletroencefalografia - Unidades de Terapia Intensiva - Encefalopatias - Mortalidade hospitalar


Publication History

Received: 21 January 2020

Accepted: 19 February 2020

Article published online:
13 June 2023

© 2020. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 San-Juan OD, Chiappa KH, Costello DJ, Cole AJ. Periodic epileptiform discharges in hypoxic encephalopathy: BiPLEDs and GPEDs as a poor prognosis for survival. Seizure. 2009 Jun;18(5):365-8. https://doi.org/10.1016/j.seizure.2009.01.003
  • 2 Li HT, Wu T, Lin WR, Tseng WEJ, Chang CW, Cheng MY, et al. Clinical correlation and prognostic implication of periodic EEG patterns: a cohort study. Epilepsy Res. 2017 Mar;131:44-50. https://doi.org/10.1016/j.eplepsyres.2017.02.004
  • 3 Foreman B, Claassen J, Khaled KA, Jirsch J, Alschuler DM, Wittman J, et al. Generalized periodic discharges in the critically ill: a case-control study of 200 patients. Neurology. 2012 Nov;79(19):1951-60. https://doi.org/10.1212/WNL.0b013e3182735cd7
  • 4 Yemisci M, Gurer G, Saygi S, Ciger A. Generalised periodic epileptiform discharges: clinical features, neuroradiological evaluation and prognosis in 37 adult patients. Seizure. 2003 Oct;12(7):465-72. https://doi.org/10.1016/s1059-1311(02)00351-5
  • 5 Sully KE, Husain AM. Generalized periodic discharges : a topical review. J Clin Neurophysiol. 2018 May;35(3):199-207. https://doi.org/10.1097/WNP.20200026202000260460.
  • 6 Hirsch LJ, Laroche SM, Gaspard N, Gerard E, Svoronos A, Herman ST, et al. American clinical neurophysiology society’s standardized critical care EEG terminology: 2012 version. J Clin Neurophysiol. 2013 Feb;30(1):1-27. https://doi.org/10.1097/WNP.0b013e3182784729.
  • 7 Lewis DW, Johnson EL. Prognosis of periodic and rhythmic patterns in adult and pediatric populations. J Clin Neurophysiol. 2018 Jul;35(4):303-8. https://doi.org/10.1097/WNP.20200026202000260442
  • 8 Ruijter BJ, van Putten MJAM, Hofmeijer J. Generalized epileptiform discharges in postanoxic encephalopathy: quantitative characterization in relation to outcome. Epilepsia. 2015 Nov;56(11):1845-54. https://doi.org/10.1111/epi.13202
  • 9 Banu SH. EEG in ICU: A monitoring tool for critically ill patient. Bangladesh Crit Care J. 2014 Ago;2(1):28-34. https://doi.org/10.3329/bccj.v2i1.19954
  • 10 Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology. 2004 May;62(10):1743-8. https://doi.org/10.1212/01.wnl.0000125184.88797.62
  • 11 Lamartine Monteiro M, Taccone FS, Depondt C, Lamanna I, Gaspard N, Ligot N, et al. The prognostic value of 48-h continuous EEG during therapeutic hypothermia after cardiac arrest. Neurocrit Care. 2016 Apr;24(2):153-62. https://doi.org/10.1007/s12028-015-0215-9
  • 12 Rundgren M, Westhall E, Cronberg T, Rosén I, Friberg H. Continuous amplitude-integrated electroencephalogram predicts outcome in hypothermia-treated cardiac arrest patients. Crit Care Med. 2010 Sep;38(9):1838-44. https://doi.org/10.1097/CCM.0b013e3181eaa1e7
  • 13 Ribeiro A, Singh R, Brunnhuber F. Clinical outcome of generalized periodic epileptiform discharges on first EEG in patients with hypoxic encephalopathy postcardiac arrest. Epilepsy Behav. 2015 Aug;49:268-72. http://dx.doi.org/10.1016/j.yebeh.2015.06.010
  • 14 Renzel R, Baumann CR, Mothersill I, Poryazova R. Persistent generalized periodic discharges: A specific marker of fatal outcome in cerebral hypoxia. Clin Neurophysiol. 2017 Jan;128(1):147-52. http://dx.doi.org/10.1016/j.clinph.2016.10.091
  • 15 Nei M, Lee JM, Shanker VL, Sperling MR. The EEG and prognosis in status epilepticus. Epilepsia. 1999 Feb;40(2):157-63. https://doi.org/10.1111/j.1528-1157.1999.tb02069.x
  • 16 Koren JP, Herta J, Pirker S, Fürbass F, Hartmann M, Kluge T, et al. Rhythmic and periodic EEG patterns of 'ictal-interictal uncertainty' in critically ill neurological patients. Clin Neurophysiol. 2016 Feb;127(2):1176-1181. https://doi.org/10.1016/j.clinph.2015.09.135
  • 17 Swisher CB, Shah D, Sinha SR, Husain AM. Baseline EEG pattern on continuous ICU EEG monitoring and incidence of seizures. J Clin Neurophysiol. 2015 Apr;32(2):147-51. https://doi.org/10.1097/WNP.20200026202000260157
  • 18 van Putten MJAM, Hofmeijer J. Generalized periodic discharges: Pathophysiology and clinical considerations. Epilepsy Behav. 2015;49:228-33. http://dx.doi.org/10.1016/j.yebeh.2015.04.007
  • 19 Tjepkema-Cloostermans MC, Hindriks R, Hofmeijer J, van Putten MJAM. Generalized periodic discharges after acute cerebral ischemia: reflection of selective synaptic failure? Clin Neurophysiol. 2014 Feb;125(2):255-62. http://dx.doi.org/10.1016/j.clinph.2013.08.005