Impact of Prolonged Periodic Epileptiform Discharges on Coma Prognosis
Neurocritical Care , 06/20/2012
Ong C et al. - Persistent spontaneous periodic epileptiform discharges (PEDs) activity in comatose patients is associated with SIRPIDs and electrographic seizures, but has no impact on the likelihood of survival or recovery of consciousness.Methods
- The authors identified all comatose patients treated in the Columbia neuro-ICU between June 2008 and August 2009 who underwent ten or more consecutive days of video cEEG monitoring (N=67), and classified them into three groups: those with prolonged PEDs (five or more consecutive days), intermittent PEDs (at least one but fewer than five consecutive days), and no PEDs.
- Outcome at discharge was assessed by the Glasgow Outcome Scale and classified as dead (GOS 1), vegetative (GOS 2), and command-following (GOS 3–5).
- Mean age was 56years, mean admission Glasgow Coma Scale score was seven, and the median duration of cEEG monitoring was 18(range 10–111)days.
- The most common diagnoses were hypoxic-ischemic encephalopathy (18 %), subarachnoid hemorrhage (16 %), epilepsy (15 %), encephalitis (15 %), metabolic encephalopathy (13 %), and intracerebral hemorrhage (12 %).
- 37 % of patients (N=25) had prolonged PEDs, 31 % (N=21) had intermittent PEDs, and 31 % (N=21) had no PEDs.
- Prolonged PEDs were associated with the presence of SIRPIDS (P=0.009), electrographic seizures (P=0.019), and number of AEDs administered (P<0.0001).
- However, the presence of intermittent or prolonged PED activity had no impact on mortality (31 % overall) or recovery of consciousness (command-following) at the time of discharge (36 % overall).