Gamaleldin Osman1, Rahul Rahangdale2, Jeffrey W Britton3, Emily J Gilmore4, Hiba Arif Haider5, Stephen Hantus6, Aline Herlopian7, Sara E Hocker3, Jong Woo Lee8, Benjamin Legros9, Michael Mendoza5, Vineet Punia6, Nishi Rampal4, Jerzy P Szaflarski10, Adam D Wallace3, M Brandon Westover11, Lawrence J Hirsch4, Nicolas Gaspard12. 1. Department of Neurology, Henry Ford Hospital, Detroit, MI, USA; Department of Neurology, Yale University School of Medicine, New Haven, CT, USA; Ain Shams University, Cairo, Egypt. 2. Department of Neurology, Yale University School of Medicine, New Haven, CT, USA; Department of Neurology, Allegheny General Hospital, Pittsburgh, PA, USA. 3. Department of Neurology, Mayo Clinic, Rochester, MN, USA. 4. Department of Neurology, Yale University School of Medicine, New Haven, CT, USA. 5. Division of Epilepsy, Department of Neurology, Emory University, Atlanta, GA, USA. 6. Cleveland Clinic Epilepsy Center, Cleveland, OH, USA. 7. Department of Neurology, Yale University School of Medicine, New Haven, CT, USA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 8. Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 9. Service de Neurologie et Centre de Référence pour le Traitement de l'Epilepsie Réfractaire, Université Libre de Bruxelles - Hôpital Erasme, Bruxelles, Belgium. 10. University of Alabama at Birmingham, Birmingham, AL, USA. 11. Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 12. Department of Neurology, Yale University School of Medicine, New Haven, CT, USA; Service de Neurologie et Centre de Référence pour le Traitement de l'Epilepsie Réfractaire, Université Libre de Bruxelles - Hôpital Erasme, Bruxelles, Belgium. Electronic address: nicolas.gaspard@ulb.ac.be.
Abstract
OBJECTIVE: To determine the clinical correlates bilateral independent periodic discharges (BIPDs) and their association with electrographic seizures and outcome. METHODS: Retrospective case-control study of patients with BIPDs compared to patients without periodic discharges ("No PDs") and patients with lateralized periodic discharges ("LPDs"), matched for age, etiology and level of alertness. RESULTS: We included 85 cases and 85 controls in each group. The most frequent etiologies of BIPDs were stroke, CNS infections, and anoxic brain injury. Acute bilateral cerebral injury was more common in the BIPDs group than in the No PDs and LPDs groups (70% vs. 37% vs. 35%). Electrographic seizures were more common with BIPDs than in the absence of PDs (45% vs. 8%), but not than with LPDs (52%). Mortality was higher in the BIPDs group (36%) than in the No PDs group (18%), with fewer patients with BIPDs achieving good outcome (moderate disability or better; 18% vs. 36%), but not than in the LPDs group (24% mortality, 26% good outcome). In multivariate analyses, BIPDs remained associated with mortality (OR: 3.0 [1.4-6.4]) and poor outcome (OR: 2.9 [1.4-6.2]). CONCLUSION: BIPDs are caused by bilateral acute brain injury and are associated with a high risk of electrographic seizures and of poor outcome. SIGNIFICANCE: BIPDs are uncommon but their identification in critically ill patients has potential important implications, both in terms of clinical management and prognostication.
OBJECTIVE: To determine the clinical correlates bilateral independent periodic discharges (BIPDs) and their association with electrographic seizures and outcome. METHODS: Retrospective case-control study of patients with BIPDs compared to patients without periodic discharges ("No PDs") and patients with lateralized periodic discharges ("LPDs"), matched for age, etiology and level of alertness. RESULTS: We included 85 cases and 85 controls in each group. The most frequent etiologies of BIPDs were stroke, CNS infections, and anoxic brain injury. Acute bilateral cerebral injury was more common in the BIPDs group than in the No PDs and LPDs groups (70% vs. 37% vs. 35%). Electrographic seizures were more common with BIPDs than in the absence of PDs (45% vs. 8%), but not than with LPDs (52%). Mortality was higher in the BIPDs group (36%) than in the No PDs group (18%), with fewer patients with BIPDs achieving good outcome (moderate disability or better; 18% vs. 36%), but not than in the LPDs group (24% mortality, 26% good outcome). In multivariate analyses, BIPDs remained associated with mortality (OR: 3.0 [1.4-6.4]) and poor outcome (OR: 2.9 [1.4-6.2]). CONCLUSION:BIPDs are caused by bilateral acute brain injury and are associated with a high risk of electrographic seizures and of poor outcome. SIGNIFICANCE: BIPDs are uncommon but their identification in critically illpatients has potential important implications, both in terms of clinical management and prognostication.
Authors: L J Hirsch; S M LaRoche; N Gaspard; E Gerard; A Svoronos; S T Herman; R Mani; H Arif; N Jette; Y Minazad; J F Kerrigan; P Vespa; S Hantus; J Claassen; G B Young; E So; P W Kaplan; M R Nuwer; N B Fountain; F W Drislane Journal: J Clin Neurophysiol Date: 2013-02 Impact factor: 2.177
Authors: Aaron F Struck; Gamaleldin Osman; Nishi Rampal; Siddhartha Biswal; Benjamin Legros; Lawrence J Hirsch; M Brandon Westover; Nicolas Gaspard Journal: Ann Neurol Date: 2017-07-19 Impact factor: 10.422
Authors: Andres Rodriguez Ruiz; Jan Vlachy; Jong Woo Lee; Emily J Gilmore; Turgay Ayer; Hiba Arif Haider; Nicolas Gaspard; J Andrew Ehrenberg; Benjamin Tolchin; Tadeu A Fantaneanu; Andres Fernandez; Lawrence J Hirsch; Suzette LaRoche Journal: JAMA Neurol Date: 2017-02-01 Impact factor: 18.302
Authors: Shobhit Singla; Gabriella E Garcia; Grace E Rovenolt; Alexandria L Soto; Emily J Gilmore; Lawrence J Hirsch; Hal Blumenfeld; Kevin N Sheth; S Bulent Omay; Aaron F Struck; M Brandon Westover; Jennifer A Kim Journal: Curr Neurol Neurosci Rep Date: 2020-07-27 Impact factor: 6.030