집중치료실에서 지속적 뇌파검사의 뇌파 패턴 분석
Analysis of the Continuous Monitored Electroencephalogram Patterns in Intensive Care Unit
1
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
이 연구의 목적은 중첩성 뇌전증을 발견하고, 처음 기록된 30 분 뇌파 패턴을 통하여 경련 가능성을 알아보고자 한다. 국제표준 10∼20법을 통하여 전극을 부착하였다. 2014년 1월부터2015년 12월까지 중환자실에 입원한 경련 의심 환자를 대상으로 하였다. 뇌파의 패턴은 주기적 방전파, 전반적 주기적 방전파, 버스트 억제파, 초점 뇌전증파, 비대칭 배경파, 전반적 서파, 삼상성 형태의 일반화 된 주기적 방전파 등 7 가지 범주로 분류하였다. 원인별 분류는 5가지 범주로 구분하였다. 전체 128명중 평균 나이는 56.9±17.5였고, 남:여 비율은 74:54명이였다. 평균 뇌파검사 기간은 5.5±5.1일 이었고 최장 33일 이였다. 주기적 방전파(N=7), 전반적 주기적 방전파(N=10), 버스트 억제파(N=6), 초점 뇌전증파(N=19), 비대칭 배경파(N=24), 전반적서파(N=51), 3상 형태의 일반화 된 주기적 방전파(N=11)이었다. 중첩성 뇌전증 환자의 원인은 원발성 증상성(N=4), 급성원발성 증상성(N=9), 급성 증상성(N=6), 진행성 뇌병증(N=2), 열성경련(N=1)이었다. 지속적 뇌파모니터링 검사는 중첩성 뇌전증을 발견하는데 유용한 검사이고, 뇌파 패턴을 통하여 경련 발생 유무를 확인할 수 있었다.
Abstract
The aim of this study was to detect the status of epilepticus and seizure based on the initial patterns observed in the first 30 minutes of continuous electroencephalogram (cEEG) monitoring. An cEEG was recorded digitally using electrodes applied according to the International 10∼20 System. The EEG data were reviewed from January 2014 to December 2015. The baselines of the EEG patterns were characterized by lateralized periodic discharges, generalized periodic discharges, burst suppression, focal epileptiform, asymmetric background, generalized slowing, and generalized periodic discharges with a triphagic wave. The etiology was classified into five categories. The subjects of this study were 128 patients (age: 56.9±17.5 years, male:female, 74:54). The mean cEEG monitoring duration was 5.5±5.1 (min:max, 1:33) days. The EEG pattern categories included lateralized periodic discharges (N=7), generalized periodic discharges (N=10), burst suppression (N=6), focal epileptiform (N=19), asymmetric background (N=24), generalized slowing (N=51), and generalized periodic discharges with a triphagic wave (N=11). The etiological classifications of the patients with status epilepticus were remote symptomatic (N=4), remote symptomatic with acute precipitant (N=9), acute symptomatic (N=6), progressive encephalopathy (N=2), and febrile seizure (N=1). cEEG monitoring was found to be useful for the diagnosis of non-convulsive epileptic seizures or status epilepticus. The seizure was confirmed by the EEG pattern.
참고문헌 (20)
- Pandian JD, "Digital video-electroencephal-ographic monitoring in the neurological-neurosurgical intensive care unit: clinical features and outcome", Arch Neurol, 61(7), pp.1090~1094 (2004)
- Amantini A, "Neurophysiological monitoring in adult and pediatric intensive care", Minerva Anestesiol, 78(9), pp.1067~1075 (2012)
- Herman ST, "Consensus statement on continuous EEG in critically ill adults and children, part I: Indications", J Clin Neurophysiol, 32(2), pp.87~95 (2015)
- Claassen J, "Detection of electrographic seizures with continuous EEG monitoring in critically ill patients", Neurology, 62(10), pp.1743~1748 (2004)
- Treiman DM, "A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group", N Engl J Med, 339(12), pp.792~798 (1998)
- DeLorenzo RJ, "Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus", Epilepsia, 39(8), pp.833~840 (1998)
- Brophy GM, "Guidelines for the evaluation and management of status epilepticus", Neurocrit Care, 17(1), pp.3~23 (2012)
- Claassen J, "Electrographic seizures and periodic discharges after intracerebral hemorrhage", Neurology, 69(13), pp.1356~1365 (2007)
- Vespa PM, "Increased incidence and impact of nonconvulsive and convulsive seizures after traumatic brain injury as detected by continuous electroencephalographic monitoring", J Neurosurg, 91(5), pp.750~760 (1999)
- Claassen J, "Detection of electrographic seizures with continuous EEG monitoring in critically ill patients", Neurology, 62(10), pp.1743~1748 (2004)
- Maytal J, "Low morbidity and mortality of status epilepticus in children", Pediatrics, 83(3), pp.323~331 (1989)
- Bernard SA, "Clinical trial of induced hypothermia in comatose survivors of out-of-hospital cardiac arrest", Ann Emerg Med, 30(2), pp.146~153 (1997)
- Badjatia N, "Predictors and clinical implications of shivering during therapeutic normothermia", Neurocrit Care, 6(3), pp.186~191 (2007)
- Plestis KA, "Continuous elec -troencephalographic monitoring and selective shunting reduces neurologic morbidity rates in carotid endarterectomy", J Vasc Surg, 25(4), pp.620~628 (1997)
- Jordan KG, "Neurophysiologic monitoring in the neuroscience intensive care unit", Neurol Clin, 13(3), pp.579~626 (1995)
- Towne AR, "Prevalence of nonconvulsive status epilepticus in comatose patients", Neurology, 54(2), pp.340~345 (2000)
- Shafi MM, "Absence of early epileptiform abnormalities predicts lack of seizures on continuous EEG", Neurology, 79(17), pp.1796~1801 (2012)
- Trinka E, "Causes of status epilepticus", Epilepsia, 53(4), pp.127~138 (2012)
- Osorio I, "Treatment of refractory generalized tonic-clonic status epilepticus with pentobarbital anesthesia after high-dose phenytoin", Epilepsia, 30(4), pp.464~471 (1989)
- Sahin M, "Outcome of severe refractory status epilepticus in children", Epilepsia, 42(11), pp.1461~1467 (2001)