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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).
