目的:无论横向定期放电(LPD)代表发作或发作间期现象,甚至它们可能代表一个或另一个的情况,仍然极具争议。横向周期性放电是,然而,当他们被锁定在临床上明显的症状时,被广泛认为是发作。我们试图研究由时间锁定的临床症状定义的“Ictal”侧向定期放电(ILPDs)的特征,以探索使用此定义将LPDs分为“Ictal”和“nonictal”类别的实用性。
方法:我们对2007年至2011年间接受非选择性适应症的长期EEG监测的成年住院患者的所有连续EEG(cEEG)报告进行了检索,以识别所有描述LPDs的报告。当被报告为与临床症状一致时间锁定时,横向定期放电被认为是ILPDs;缺乏明确时间锁定相关性的LPDs被认为是“非临时”横向定期放电(NILPDs)。还审查了患者图表和可用的神经影像学研究。LPDs的神经生理定位,影像学发现,癫痫发作的存在,出院结果,和其他人口统计学因素在ILPDs患者和NILPDs患者之间进行了比较。针对错误发现率(FDR)调整p值。
结果:2007年至2011年期间,我们机构有一千四百52名患者接受了cEEG监测。据报道,90例患者出现了横向定期出院,其中10人符合ILPDs标准。9例ILPDs患者表现出运动症状,其余患者出现了刻板的感觉症状。Ictal侧向定期放电显着增加了涉及中央头部区域的几率(优势比[OR]=11;95%置信区间[CI]=2.16-62.6;p=0.018,FDR调整),涉及原发性感觉运动皮质的病变比例有增加的趋势(p=0.09,FDR调整)。
结论:当定义为存在时间锁定的临床相关性时,ILPD似乎与中央EEG定位密切相关。这可能是由于中央头部区域的皮质烦躁,具有更大的阳性表现倾向,临床上明显的,和时间锁定的症状。因此,在此基础上,ILPDs和NILPDs的二分法主要反映了周期性放电的潜在解剖位置的差异,而不是提供临床上突出的分类。
OBJECTIVE: Whether lateralized periodic discharges (
LPDs) represent ictal or interictal phenomena, and even the circumstances in which they may represent one or the other, remains highly controversial. Lateralized periodic discharges are, however, widely accepted as being ictal when they are time-locked to clinically apparent symptoms. We sought to investigate the characteristics of \"ictal\" lateralized periodic discharges (ILPDs) defined by time-locked clinical symptoms in order to explore the utility of using this definition to dichotomize
LPDs into \"ictal\" and \"nonictal\" categories.
METHODS: Our archive of all continuous EEG (cEEG) reports of adult inpatients undergoing prolonged EEG monitoring for nonelective indications between 2007 and 2011 was searched to identify all reports describing
LPDs. Lateralized periodic discharges were considered ILPDs when they were reported as being consistently time-locked to clinical symptoms;
LPDs lacking a clear time-locked correlate were considered to be \"nonictal\" lateralized periodic discharges (NILPDs). Patient charts and available neuroimaging studies were also reviewed. Neurophysiologic localization of
LPDs, imaging findings, presence of seizures, discharge outcomes, and other demographic factors were compared between patients with ILPDs and those with NILPDs. p-Values were adjusted for false discovery rate (FDR).
RESULTS: One thousand four hundred fifty-two patients underwent cEEG monitoring at our institution between 2007 and 2011. Lateralized periodic discharges were reported in 90 patients, 10 of whom met criteria for ILPDs. Nine of the patients with ILPDs demonstrated motor symptoms, and the remaining patient experienced stereotyped sensory symptoms. Ictal lateralized periodic discharges had significantly increased odds for involving central head regions (odds ratio [OR]=11; 95% confidence interval [CI]=2.16-62.6; p=0.018, FDR adjusted), with a trend towards higher proportion of lesions involving the primary sensorimotor cortex (p=0.09, FDR adjusted).
CONCLUSIONS: When defined by the presence of a time-locked clinical correlate, ILPDs appear to be strongly associated with a central EEG localization. This is likely due to cortical irritability in central head regions having greater propensity to manifest with positive, clinically apparent, and time-locked symptoms. Thus, dichotomization of ILPDs and NILPDs on this basis principally reflects differences in underlying anatomical locations of the periodic discharges rather than providing a clinically salient categorization.