Pseudoperiodic lateralized paroxysmal discharges in electroencephalogram

Markand, Omkar N.; Daly, David D.

doi:10.1212/wnl.21.10.975

Cited by 113 publications

(47 citation statements)

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“…In general, PEDs have been associated with a poor prognosis, because they tend to occur in acutely ill individuals (8,13,16). They are most often associated with acute structural lesions, although they may also occur in the setting of metabolic derangements (1 3, [17][18][19].…”

Section: Discussionmentioning

confidence: 99%

The EEG and Prognosis in Status Epilepticus

et al. 1999

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Summary:Purpose: To examine the relation between specific EEG features and clinical outcome, determine whether a predictable sequence of EEG patterns exists during status epilepticus (SE), and examine the relation between periodic epileptiform discharges (PEDs) and SE.Methods: EEG records of 50 patients with SE admitted to Graduate Hospital between January 1990 and July 1995 were reviewed. Ictal EEGs were available in 72%; 28% had only postictal EEGs. Poor outcome was defined as death or persistent vegetative state, and good outcome as all others. Fisher's Exact test, xz. and t tests were performed for data analysis.Results: Of 50 patients, 72% had a good outcome and 28%, a poor outcome. If PEDs were present at any time during or after SE, outcome tended to be worse (p = 0.053). With PEDs, eight (44%) of 18 had a poor outcome; without PEDs, six (19%) of 32 had a poor outcome. Etiologies for SE did not substantially differ in patients with or without PEDs, and structural abnormalities were not more associated with the presence of PEDs. PEDs were seen both early and late, during and after SE. Other EEG characteristics (lateralized vs. bilateral symmetric ictal EEG, discrete vs. continuous ictal activity, and postictal focal slowing) did not relate to outcome. No predictable sequence of EEG changes was found during SE.Conclusions: PEDs are the only EEG feature related to outcome in SE and are associated with poor outcome independent of etiology. Key Words: Status epilepticus-Periodic epileptiform discharge-PLEDs-Prognosis-EEG.Status epilepticus (SE) is a common medical emergency associated with significant morbidity and mortality. Recent estimates of the incidence of SE in the United States range from 50,000 (1) to 152,000 cases per year (1,2). Mortality in SE ranges from 2 to 27% and is higher in some subgroups (1,(3)(4)(5)(6).The EEG is an important tool in both diagnosing and managing patients with SE. Many types of EEG abnormalities can be seen during SE (7,8 nosis than the early stages of SE and that PEDs represent a late stage of SE. However, there is considerable controversy regarding the relation of PEDs to SE. PEDs, especially when lateralized, occur in the absence of seizures and have been associated with the presence of underlying structural lesions, including acute cerebral infarctions, tumors, and inflammatory conditions (8,ll). In contrast, some other studies found a close relation between seizures and PEDs (1 2,13). Although specific stages of SE have been described in an experimental model, human studies have not demonstrated any reliable EEG sequence during SE (4,14).The goals of this study were to determine whether any EEG features predict prognosis in human SE, to determine whether a predictable sequence of EEG patterns exists during SE, and to examine the relation between PEDs and SE. It is important to define which patients are at risk for poor outcome, so that new therapeutic measures can be developed on appropriate populations.

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Section: Discussionmentioning

confidence: 99%

The EEG and Prognosis in Status Epilepticus

et al. 1999

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“…Os achados mais específicos relatados nesses casos são as descargas epileptiformes paroxísticas lateralizadas (PLEDs), porém são pouco freqüentes 3,4,12,18,24 . Esses achados relacionaram-se a crises recorrentes nos estudos de Gupta et al 12 .…”

Section: Discussionunclassified

Exames subsidiários preditivos de crises epilépticas após acidente vascular cerebral isquêmico

Fukujima¹,

Cardeal

1997

Arq. Neuro-Psiquiatr.

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RESUMO -Na tentativa de detectar fatores preditivos para ocorrência de crises epilépticas após acidente vascular cerebral isquêmico (AVCI), estudamos exames laboratoriais de glicemia, hematócrito, colesterol total e frações e triglicérides, além de eletrocardiograma, eletrencefalograma (EEG), líquido cefalorraquiano e tomografia computadorizada do crânio (TC) em 35 pacientes com AVCI que evoluíram com crises epilépticas após pelo menos 24 horas a partir da instalação do AVCI (grupo 1 ou G1), que foram comparados a 35 pacientes com AVCI que evoluíram sem crises epilépticas (grupo 2 ou G2). Encontramos significância na análise EEG na comparação dos grupos, sendo a alteração mais freqüente o alentecimento focai da atividade elétrica cerebral no G1. A presença de lesão extensa na TC também associou-se ao G1. A associação de EEG anormal e lesão extensa na TC pode ser considerado elemento preditivo para ocorrência de crises epilépticas após AVCI com coeficiente de concordância de 34%. Os demais exames estudados não mostraram significância na comparação entre os grupos G1 e G2. PALAVRAS-CHAVE: doença cerebrovascular, infarto cerebral, epilepsia, eletrencefalograma, tomografia. Epileptic seizures after ischemic stroke: are there any preditive laboratory test?ABSTRACT -We studied subsidiary laboratorial tests such as serum glucose, red blood cell count, total cholesterol, HDL and LDL cholesterol and triglycerides, eletrocardiogram, eletroencephalogram (EEG), cerebrospinal fluid, and CT scan of 35 patients with cerebral infarction who developed epileptic seizures (group 1 or G1), and compared them to a group of 35 patients who had cerebral infarction but have not developed epileptic seizures (group 2 or G2). The EEG analysis showed significance in the comparison between the groups; focal lentification of the electrical cerebral activity was the most frequent abnormality found in G1. Extensive infarcts were also more frequent in G1. The association of abnormal EEG and extensive lesion on CT may be considered a preditive factor for occurrence of epileptic seizures after cerebral infarction. The analysis of the other tests showed no significance on the comparison between the groups. KEY WORDS: stroke, cerebral infarction, epilepsy, epileptic seizures, eletroencephalography, tomography.As crises epilépticas constituem importante complicação dos acidentes vasculares cerebrais (AVC), ocorrendo em 3,3 a 4,3% dos AVC na fase aguda, isto é, nos primeiros 14 dias desde sua instalação, e em 3 a 19% dos AVC na fase tardia, ou seja, após 14 dias da sua instalação 9,17,19,20,23,25 . Há dois principais mecanismos fisiopatológicos para explicar a ocorrência de crises epilépticas relacionadas ao AVC. As crises da fase aguda ocorreriam devido a alterações metabólicas citotóxicas conseqüentes à lesão cerebral, que poderiam induzir crises epilépticas por si só, ou poderiam ocorrer Este estudo faz parte da Tese de Mestrado "Crises epilépticas após acidente vascular cerebral por infarto cerebral: estudo de 35 pacientes" 10 , aprovada no Curso

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“…Since the initial description by Chatrian et al [31], many authors have emphasized the close relationship between PLEDs and acute hemispheric insult; in these studies 30-50% of the patients with PLEDs had had a stroke as the underlying etiology [31][32][33][34][35][36]. When PLEDs were seen in conjunction with stroke, 70-100% of the patients experienced some form of seizure, these were usually focal and often showed secondary generalization and even status epilepticus [9, 32, 33, 35- [23].…”

Section: Summary O F Retrospective Studies O F Eeg Findings In Strokementioning

confidence: 99%

Stroke and Epilepsy: Critical Review of the Literature

Pohlmann‐Eden¹,

Cochius

Hoch

et al. 1997

Cerebrovasc Dis

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Many questions regarding the mechanisms underlying the development of seizures in cerebral stroke remain unanswered. However, the continued critical investigation of this important issue is likely to ultimately lead to a better understanding of early focal hyperexcitability after stroke and late epileptogenesis. Part II of this critical review continues to identify risk factors for seizures after stroke focussing on ischemic conditions with special regard to stroke distribution, predictive EEG patterns, pathophysiology and the somewhat confusing ''overlap syndromes'' that may involve both vascular and ictal phenomena.

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Pseudoperiodic lateralized paroxysmal discharges in electroencephalogram

Cited by 113 publications

References 0 publications

The EEG and Prognosis in Status Epilepticus

The EEG and Prognosis in Status Epilepticus

Exames subsidiários preditivos de crises epilépticas após acidente vascular cerebral isquêmico

Stroke and Epilepsy: Critical Review of the Literature

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