Evolution of EEG Findings in Patients with Acute Brain Injury
Abstract number :
2.117
Submission category :
3. Neurophysiology / 3B. ICU EEG
Year :
2024
Submission ID :
741
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Jackson Narrett, MD – Comprehensive Epilepsy Center, Department of Neurology, Yale New Haven Hospital
MarieElena Byrnes, DO, MS – Epilepsy Center, Neurological Institute, Cleveland Clinic
Emily Gilmore, MD, FNCS, FACNS – Comprehensive Epilepsy Center, Department of Neurology, Yale New Haven Hospital
Lawrence Hirsch, MD – Yale University School of Medicine
Vineet Punia, MD – Cleveland Clinic
Adithya Sivaraju, MD, MHA – Yale School of Medicine
Rationale: The increasing use of continuous EEG monitoring (cEEG) provides the opportunity to observe temporal trends in EEG patterns during the acute phase of brain injury. These trends have not been extensively documented.
Methods: We conducted a retrospective chart review of patients undergoing cEEG between January 1st and June 30th, 2019, at two academic medical centers. Only patients with acute brain injury having electrographic or electroclinical seizures or epileptic EEG findings on day one of monitoring and ≥ two calendar days of cEEG were included. The temporal evolution of EEG patterns was depicted as a heatmap. A stacked bar chart was used to display the percentages of patients with each initial EEG finding that had resolution, improvement, persistence, or worsening of their EEG finding between the first and last monitored day during hospitalization for acute brain injury.
Results: Of 1356 screened patients, 101 met the study criteria. Clinical acute symptomatic seizures occurred in 30 patients (29.7%) prior to EEG. The median number of days of cEEG was four (IQR 3-6). Amongst patients with seizures, status epilepticus (SE), generalized periodic discharges (GPDs), or sporadic epileptiform discharges (SEDs), 24.6% had improvement and 54.1% had resolution of epileptic EEG findings by the final day of monitoring. In contrast, 65% with lateralized periodic discharges (LPDs) or lateralized rhythmic delta activity (LRDA) persisted or worsened. Overall, 61.4% (62/101) showed either improvement (19.8%) or resolution (41.6%) of their EEG findings prior to discharge. Of the 36 patients with follow-up EEGs at a median of 4.5 (IQR 3-8) months after admission for acute brain injury, 83% (30/36) showed either improvement (1/36; 2.7%) or resolution (29/36; 80.6%).
Conclusions: We observed a trend towards normalization of most epileptiform patterns, except LPDs and LRDA, over time in patients with acute brain injury. This trend warrants further investigation in an independent cohort. Our findings may inform future studies evaluating optimal antiseizure medication treatment duration, risk of developing epilepsy, and neurologic outcomes in patients with acute brain injury and acute symptomatic seizures or epileptiform EEG findings.
Funding: No funding was received in support of this abstract.
Neurophysiology