重症患者连续脑电图监测中发作期-发作间期连续体的研究进展

Advances in the study of ictal-interictal continuum in continuous electroencephalography monitoring for critical ill patients

连续脑电图监测是一种可实时监测重症患者脑功能变化和亚临床癫痫发作情况的技术,被广泛应用于神经重症病房中。在所有监测到的异常脑电图波形中,发作期-发作间期连续体不属于明确的发作期或发作间期波形但同样存在可能的发作性特征及癫痫发作的风险,其中单侧放电、频率大于2 Hz及叠加其他波形成分的异常波形可能导致癫痫发作的风险更高。然而,目前针对该异常脑电现象的研究在许多方面仍未取得一致的结论,尤其在临床治疗流程上尚无指南可循。文中将全面、系统地梳理此类波形的临床特点及可能导致癫痫发作的高风险特征,为临床及时干预、提早应对并改善患者预后提供参考。

Continuous electroencephalography monitoring,as a technique that allows for monitoring brain activity in a real-time manner and detecting sub-clinical seizures,has been extensively used in neurological intensive care unit.The so-called"ictal-interictal continuum"(IIC)is a special kind of rhythmic or periodic wave patterns that differs from those clearly defined as ictal or interictal.Current research shows that patterns with lateralized discharges,frequency>2 Hz and modifiers"plus"may result in a higher risk of seizure and may contribute to secondary neuronal injury.However,no consensus agreement has been reached so far on the definition or on the clinical treatment.In this paper,we systematically survey the current work on the clinical characters and high-risk factors of IIC that may contribute to a seizure.Our work provides a possible reference for clinical advanced awareness,timely intervention and improvement of patient outcome.