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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Generalized periodic discharges in the critically ill : A case-control study of 200 patients
Neurology, Volume 79, No. 19, Year 2012
Notification
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Description
Objective: Generalized periodic discharges are increasingly recognized on continuous EEG monitoring, but their relationship to seizures and prognosis remains unclear. Methods: All adults with generalized periodic discharges from 1996 to 2006 were matched 1:1 to controls by age, etiology, and level of consciousness. Overall, 200 patients with generalized periodic discharges were matched to 200 controls. Results: Mean age was 66 years (range 18-96); 56% were comatose. Presenting illnesses included acute brain injury (44%), acute systemic illness (38%), cardiac arrest (15%), and epilepsy (3%). A total of 46% of patients with generalized periodic discharges had a seizure during their hospital stay (almost half were focal), vs 34% of controls (p < 0.014). Convulsive seizures were seen in a third of both groups. A total of27%of patients with generalized periodic discharges had nonconvulsive seizures, vs8%of controls (p<0.001); 22% of patients with generalized periodic discharges had nonconvulsive status epilepticus, vs 7% of controls (p = 0.001). In both groups, approximately half died or were in a vegetative state, one-third had severe disability, and one-fifth had moderate to no disability. Excluding cardiac arrest patients, generalized periodic discharges were associated with increased mortality on univariate analysis (36.8% vs 26.9%; p - 0.049). Multivariate predictors of worse outcome were cardiac arrest, coma, nonconvulsive status epilepticus, and sepsis, but not generalized periodic discharges. Conclusion: Generalized periodic discharges were strongly associated with nonconvulsive seizures and nonconvulsive status epilepticus. While nonconvulsive status epilepticus was independently associated with worse outcome, generalized periodic discharges were not after matching for age, etiology, and level of consciousness. © 2012 American Academy of Neurology.
Authors & Co-Authors
Foreman, Brandon
United States, New York
The Neurological Institute of new York
Claassen, Jan
United States, New York
The Neurological Institute of new York
Khaled, Karine Abou
Lebanon, Beirut
Hôtel-dieu de France Hospital
Jirsch, Jeffrey
Canada, Edmonton
University of Alberta
Alschuler, Daniel M.
United States, New York
New York State Psychiatric Institute
JohnWittman, John
United States
Neurological Associates, Inc.
Emerson, Ronald G.
United States, New York
Hospital for Special Surgery - new York
Hirsch, Lawrence J.
United States, New Haven
Yale School of Medicine
Statistics
Citations: 161
Authors: 8
Affiliations: 7
Identifiers
Doi:
10.1212/WNL.0b013e3182735cd7
ISSN:
00283878
e-ISSN:
1526632X
Research Areas
Disability
Health System And Policy
Noncommunicable Diseases
Violence And Injury
Study Design
Case-Control Study