PDF(Pubmed)
Abstract：
To investigate the frequency of induced EEG burst suppression pattern during continuous IV anesthesia (IVAD) and associated outcomes in adult patients treated for refractory status epilepticus (RSE).
Patients with RSE treated with anesthetics at a Swiss academic care center from 2011 to 2019 were included. Clinical data and semiquantitative EEG analyses were assessed. Burst suppression was categorized as incomplete burst suppression (with ≥20% and <50% suppression proportion) or complete burst suppression (with ≥50% suppression proportion). The frequency of induced burst suppression and association of burst suppression with outcomes (persistent seizure termination, in-hospital survival, and return to premorbid neurologic function) were the endpoints.
We identified 147 patients with RSE treated with IVAD. Among 102 patients without cerebral anoxia, incomplete burst suppression was achieved in 14 (14%) with a median of 23 hours (interquartile range [IQR] 1-29) and complete burst suppression was achieved in 21 (21%) with a median of 51 hours (IQR 16-104). Age, Charlson comorbidity index, RSE with motor symptoms, the Status Epilepticus Severity Score and arterial hypotension requiring vasopressors were identified as potential confounders in univariable comparisons between patients with and without any burst suppression. Multivariable analyses revealed no associations between any burst suppression and the predefined endpoints. However, among 45 patients with cerebral anoxia, induced burst suppression was associated with persistent seizure termination (72% without vs 29% with burst suppression, p = 0.004) and survival (50% vs 14% p = 0.005).
In adult patients with RSE treated with IVAD, burst suppression with ≥50% suppression proportion was achieved in every fifth patient and not associated with persistent seizure termination, in-hospital survival, or return to premorbid neurologic function.
Patients with RSE treated with anesthetics at a Swiss academic care center from 2011 to 2019 were included. Clinical data and semiquantitative EEG analyses were assessed. Burst suppression was categorized as incomplete burst suppression (with ≥20% and <50% suppression proportion) or complete burst suppression (with ≥50% suppression proportion). The frequency of induced burst suppression and association of burst suppression with outcomes (persistent seizure termination, in-hospital survival, and return to premorbid neurologic function) were the endpoints.
We identified 147 patients with RSE treated with IVAD. Among 102 patients without cerebral anoxia, incomplete burst suppression was achieved in 14 (14%) with a median of 23 hours (interquartile range [IQR] 1-29) and complete burst suppression was achieved in 21 (21%) with a median of 51 hours (IQR 16-104). Age, Charlson comorbidity index, RSE with motor symptoms, the Status Epilepticus Severity Score and arterial hypotension requiring vasopressors were identified as potential confounders in univariable comparisons between patients with and without any burst suppression. Multivariable analyses revealed no associations between any burst suppression and the predefined endpoints. However, among 45 patients with cerebral anoxia, induced burst suppression was associated with persistent seizure termination (72% without vs 29% with burst suppression, p = 0.004) and survival (50% vs 14% p = 0.005).
In adult patients with RSE treated with IVAD, burst suppression with ≥50% suppression proportion was achieved in every fifth patient and not associated with persistent seizure termination, in-hospital survival, or return to premorbid neurologic function.
摘要：
目的：探讨持续静脉麻醉（IVAD）过程中诱导脑电图（EEG）爆发抑制模式的频率和治疗难治性癫痫持续状态（RSE）的成人患者的相关结局。
方法：纳入了2011-2019年在瑞士学术护理中心接受麻醉药治疗的RSE患者。评估了临床数据和半定量EEG分析。突发抑制分为不完全突发抑制(抑制比例≥20%且<50%)或完全突发抑制(抑制比例≥50%)。诱导脉冲串抑制的频率，以及爆发抑制与结果的关联(持续性癫痫发作终止，在医院生存，并恢复病前神经功能）是终点。
结果：我们确定了147例接受IVAD治疗的RSE患者。102例无脑缺氧的病人,14例(14%)实现了不完全爆发抑制,中位时间为23小时(四分位距[IQR]1-29),21例(21%)实现了完全爆发抑制,中位时间为51小时(IQR16-104).年龄,Charlson合并症指数，有运动症状的RSE,和癫痫持续状态严重程度评分(STESS)被确定为有和没有任何爆发抑制的患者之间的单变量比较中的潜在混杂因素.多变量分析显示，任何突发抑制与预定义的端点之间都没有关联。然而,在45例脑缺氧患者中，诱导爆发抑制与持续性癫痫发作终止相关(72%无vs.29%的脉冲串抑制，p=0.004）和生存率（50%vs.14%p=0.005)。
结论：在接受IVAD治疗的成人RSE患者中，每5例患者中实现了抑制比例≥50%的爆发抑制,与持续性癫痫发作终止无关,住院生存或恢复病前神经功能。
方法：纳入了2011-2019年在瑞士学术护理中心接受麻醉药治疗的RSE患者。评估了临床数据和半定量EEG分析。突发抑制分为不完全突发抑制(抑制比例≥20%且<50%)或完全突发抑制(抑制比例≥50%)。诱导脉冲串抑制的频率，以及爆发抑制与结果的关联(持续性癫痫发作终止，在医院生存，并恢复病前神经功能）是终点。
结果：我们确定了147例接受IVAD治疗的RSE患者。102例无脑缺氧的病人,14例(14%)实现了不完全爆发抑制,中位时间为23小时(四分位距[IQR]1-29),21例(21%)实现了完全爆发抑制,中位时间为51小时(IQR16-104).年龄,Charlson合并症指数，有运动症状的RSE,和癫痫持续状态严重程度评分(STESS)被确定为有和没有任何爆发抑制的患者之间的单变量比较中的潜在混杂因素.多变量分析显示，任何突发抑制与预定义的端点之间都没有关联。然而,在45例脑缺氧患者中，诱导爆发抑制与持续性癫痫发作终止相关(72%无vs.29%的脉冲串抑制，p=0.004）和生存率（50%vs.14%p=0.005)。
结论：在接受IVAD治疗的成人RSE患者中，每5例患者中实现了抑制比例≥50%的爆发抑制,与持续性癫痫发作终止无关,住院生存或恢复病前神经功能。
