Abstract：
BACKGROUND: The ictal-interictal continuum (IIC) consists of several electroencephalogram (EEG) patterns that are common in critically ill adults. Studies focused on the IIC are limited in critically ill children and have focused primarily on associations with electrographic seizures (ESs). We report the incidence of the IIC in the pediatric intensive care unit (PICU). We then compare IIC patterns to rhythmic and periodic patterns (RPP) not meeting IIC criteria looking for associations with acute cerebral abnormalities, ES, and in-hospital mortality.
METHODS: This was a retrospective review of prospectively collected data for patients admitted to the PICU at Children\'s National Hospital from July 2021 to January 2023 with continuous EEG. We excluded patients with known epilepsy and cerebral injury prior to presentation. All patients were screened for RPP. The American Clinical Neurophysiology Society standardized Critical Care EEG terminology for the IIC was applied to each RPP. Associations between IIC and RPP not meeting IIC criteria, with clinical and EEG variables, were calculated using odds ratios (ORs).
RESULTS: Of 201 patients, 21% (42/201) had RPP and 12% (24/201) met IIC criteria. Among patients with an IIC pattern, the median age was 3.4 years (interquartile range (IQR) 0.6-12 years). Sixty-seven percent (16/24) of patients met a single IIC criterion, whereas the remainder met two criteria. ESs were identified in 83% (20/24) of patients and cerebral injury was identified in 96% (23/24) of patients with IIC patterns. When comparing patients with IIC patterns with those with RPP not qualifying as an IIC pattern, both patterns were associated with acute cerebral abnormalities (IIC OR 26 [95% confidence interval {CI} 3.4-197], p = 0.0016 vs. RPP OR 3.5 [95% CI 1.1-11], p = 0.03), however, only the IIC was associated with ES (OR 121 [95% CI 33-451], p < 0.0001) versus RPP (OR 1.3 [0.4-5], p = 0.7).
CONCLUSIONS: Rhythmic and periodic patterns and subsequently the IIC are commonly seen in the PICU and carry a high association with cerebral injury. Additionally, the IIC, seen in more than 10% of critically ill children, is associated with ES. The independent impact of RPP and IIC patterns on secondary brain injury and need for treatment of these patterns independent of ES requires further study.
METHODS: This was a retrospective review of prospectively collected data for patients admitted to the PICU at Children\'s National Hospital from July 2021 to January 2023 with continuous EEG. We excluded patients with known epilepsy and cerebral injury prior to presentation. All patients were screened for RPP. The American Clinical Neurophysiology Society standardized Critical Care EEG terminology for the IIC was applied to each RPP. Associations between IIC and RPP not meeting IIC criteria, with clinical and EEG variables, were calculated using odds ratios (ORs).
RESULTS: Of 201 patients, 21% (42/201) had RPP and 12% (24/201) met IIC criteria. Among patients with an IIC pattern, the median age was 3.4 years (interquartile range (IQR) 0.6-12 years). Sixty-seven percent (16/24) of patients met a single IIC criterion, whereas the remainder met two criteria. ESs were identified in 83% (20/24) of patients and cerebral injury was identified in 96% (23/24) of patients with IIC patterns. When comparing patients with IIC patterns with those with RPP not qualifying as an IIC pattern, both patterns were associated with acute cerebral abnormalities (IIC OR 26 [95% confidence interval {CI} 3.4-197], p = 0.0016 vs. RPP OR 3.5 [95% CI 1.1-11], p = 0.03), however, only the IIC was associated with ES (OR 121 [95% CI 33-451], p < 0.0001) versus RPP (OR 1.3 [0.4-5], p = 0.7).
CONCLUSIONS: Rhythmic and periodic patterns and subsequently the IIC are commonly seen in the PICU and carry a high association with cerebral injury. Additionally, the IIC, seen in more than 10% of critically ill children, is associated with ES. The independent impact of RPP and IIC patterns on secondary brain injury and need for treatment of these patterns independent of ES requires further study.
摘要：
背景：发作间连续体（IIC）由几种在危重患者中常见的脑电图（EEG）模式组成。针对IIC的研究仅限于危重病儿童，主要集中在与心电图癫痫发作（ESs）的关联上。我们报告了儿科重症监护病房（PICU）中IIC的发生率。然后，我们将IIC模式与不符合IIC标准的节律和周期性模式（RPP）进行比较，以寻找与急性大脑异常的关联。ES,和住院死亡率。
方法：这是一项回顾性研究，对2021年7月至2023年1月儿童国家医院PICU住院患者的前瞻性数据进行了回顾性分析，并进行了连续脑电图检查。在就诊前，我们排除了已知癫痫和脑损伤的患者。所有患者均进行RPP筛查。美国临床神经生理学会将IIC的重症监护EEG术语标准化应用于每个RPP。IIC和RPP之间的关联不符合IIC标准，临床和脑电图变量，使用比值比(OR)计算。
结果：在201例患者中，21%(42/201)具有RPP,12%(24/201)符合IIC标准。在有IIC模式的患者中，中位年龄为3.4岁(四分位距(IQR)0.6~12岁).67%（16/24）的患者符合单一的IIC标准，而其余的则符合两个标准。在83％（20/24）的患者中发现了ESs，在96％（23/24）的IIC模式患者中发现了脑损伤。当比较IIC模式的患者与RPP不符合IIC模式的患者时，两种模式均与急性脑异常相关(IICOR26[95%置信区间{CI}3.4-197]，p=0.0016vs.RPPOR3.5[95%CI1.1-11]，p=0.03),然而,只有IIC与ES相关(OR121[95%CI33-451]，p<0.0001)与RPP(OR1.3[0.4-5]，p=0.7)。
结论：节律和周期性模式以及随后的IIC在PICU中常见，并与脑损伤高度相关。此外,IIC,在10%以上的危重儿童中观察到，与ES相关联。RPP和IIC模式对继发性脑损伤的独立影响以及独立于ES的这些模式的治疗需要进一步研究。
方法：这是一项回顾性研究，对2021年7月至2023年1月儿童国家医院PICU住院患者的前瞻性数据进行了回顾性分析，并进行了连续脑电图检查。在就诊前，我们排除了已知癫痫和脑损伤的患者。所有患者均进行RPP筛查。美国临床神经生理学会将IIC的重症监护EEG术语标准化应用于每个RPP。IIC和RPP之间的关联不符合IIC标准，临床和脑电图变量，使用比值比(OR)计算。
结果：在201例患者中，21%(42/201)具有RPP,12%(24/201)符合IIC标准。在有IIC模式的患者中，中位年龄为3.4岁(四分位距(IQR)0.6~12岁).67%（16/24）的患者符合单一的IIC标准，而其余的则符合两个标准。在83％（20/24）的患者中发现了ESs，在96％（23/24）的IIC模式患者中发现了脑损伤。当比较IIC模式的患者与RPP不符合IIC模式的患者时，两种模式均与急性脑异常相关(IICOR26[95%置信区间{CI}3.4-197]，p=0.0016vs.RPPOR3.5[95%CI1.1-11]，p=0.03),然而,只有IIC与ES相关(OR121[95%CI33-451]，p<0.0001)与RPP(OR1.3[0.4-5]，p=0.7)。
结论：节律和周期性模式以及随后的IIC在PICU中常见，并与脑损伤高度相关。此外,IIC,在10%以上的危重儿童中观察到，与ES相关联。RPP和IIC模式对继发性脑损伤的独立影响以及独立于ES的这些模式的治疗需要进一步研究。
