Lateralized Periodic Discharges Frequency Correlates With Glucose Metabolism Subramaniam T, Jain A, Hall LT, Cole AJ, Westover MB, Rosenthal ES, Struck AF. Neurology. 2019;92(7):e670-e674. OBJECTIVE To investigate the correlation between characteristics of lateralized periodic discharges (LPDs) and glucose metabolism measured by (18)F-fluorodeoxyglucose (FDG)-positron emission tomography (PET). METHODS We retrospectively reviewed medical records to identify patients who underwent FDG-PET during electroencephalography (EEG) monitoring with LPDs present during the FDG uptake period. Two blinded board-certified neurophysiologists independently interpreted EEGs. (18)F-fluorodeoxyglucose uptake was measured using standardized uptake value (SUV). Structural images were fused with PET images to aid with localization of SUV. Two PET readers independently measured maximum SUV. Relative SUV values were obtained by normalization of the maximum SUV to the SUV of pons (SUVRpons). Lateralized periodic discharge frequency was analyzed both as a categorical variable and as a continuous measure. Other secondary variables included duration, amplitude, presence of structural lesion, and "plus" EEG features such as rhythmic or fast sharp activity. RESULTS Nine patients were identified and 7 had a structural etiology for LPDs. Analysis using frequency as a categorical variable and continuous variable showed an association between increased LPD frequency and increased ipsilateral SUVRpons (P = .02). Metabolism associated with LPDs (0.5 Hz as a baseline) increased by a median of 100% at 1 Hz and for frequencies >1 Hz increased by a median of 309%. There were no statistically significant differences in SUVRpons for other factors including duration (P = .10), amplitude (P = .80), structural etiology (P = .55), or "plus" features such as rhythmic or fast sharp activity (P = .84). CONCLUSIONS Metabolic activity increases monotonically with LPD frequency. Lateralized periodic discharge frequency should be a measure of interest when developing neuroprotection strategies in critical neurologic illness. Continuous Electroencephalography After Moderate to Severe Traumatic Brain Injury Lee H, Mizrahi MA, Hartings JA, Sharma S, Pahren L, Ngwenya LB, Moseley BD, Privitera M, Tortella FC, Foreman B. Crit Care Med. 2019;47(4):574-582. OBJECTIVES After traumatic brain injury, continuous electroencephalography is widely used to detect electrographic seizures. With the development of standardized continuous electroencephalography terminology, we aimed to describe the prevalence and burden of ictal-interictal patterns, including electrographic seizures after moderate to severe traumatic brain injury, and to correlate continuous electroencephalography features with functional outcome. DESIGN Post hoc analysis of the prospective, randomized controlled phase 2 multicenter INTREPID study ( ClinicalTrials.gov : NCT00805818). Continuous electroencephalography was initiated upon admission to the intensive care unit. The primary outcome was the 3-month Glasgow Outcome Scale-Extended. Consensus electroencephalography reviews were performed by raters certified in standardized continuous electroencephalography terminology blinded to clinical data. Rhythmic, periodic, or ictal patterns were referred to as "ictal-interictal continuum"; severe ictal-interictal continuum was defined as greater than or equal to 1.5 Hz lateralized rhythmic delta activity or generalized periodic discharges and any lateralized periodic discharges or electrographic seizures. SETTING Twenty US level I trauma centers. PATIENTS Patients with nonpenetrating traumatic brain injury and postresuscitation Glasgow Coma Scale score of 4 to 12 were included. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Among 152 patients with continuous electroencephalography (age = 34 ± 14 years; 88% male), 22 (14%) had severe ictal-interictal continuum including electrographic seizures in 4 (2.6%). Severe ictal-interictal continuum burden correlated with initial prognostic scores, including the International Mission for Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury (r = 0.51; P = .01) and Injury Severity Score (r = 0.49; P = .01), but not with functional outcome. After controlling clinical covariates, unfavorable outcome was independently associated with absence of posterior dominant rhythm (common odds ratio, 3.38; 95% confidence interval, 1.30-9.09), absence of N2 sleep transients (3.69; 1.69-8.20), predominant delta activity (2.82; 1.32-6.10), and discontinuous background (5.33; 2.28-12.96) within the first 72 hours of monitoring. CONCLUSIONS Severe ictal-interictal continuum patterns, including electrographic seizures, were associated with clinical markers of injury severity but not functional outcome in this prospective cohort of patients with moderate to severe traumatic brain injury. Importantly, continuous electroencephalography background features were independently associated with functional outcome and improved the area under the curve of existing, validated predictive models.

中文翻译：

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EEG发作间期连续体-一种新陈代谢的轰鸣声，但对功能结果的耳语。

横向周期性放电频率与葡萄糖代谢相关，Subramaniam T，Jain A，Hall LT，Cole AJ，Westover MB，Rosenthal ES，Strike AF。神经病学。2019; 92（7）：e670-e674。目的探讨（18）F-氟脱氧葡萄糖（FDG）-正电子发射断层显像（PET）测量的周期性周期性放电（LPDs）特征与葡萄糖代谢之间的相关性。方法我们回顾性地回顾了病历，以识别在脑电图（EEG）监测期间接受FDG-PET治疗且患者在FDG摄取期间存在LPD的患者。两名由盲人委员会认证的神经生理学家独立解释了脑电图。（18）使用标准摄取值（SUV）测量F-氟脱氧葡萄糖摄取。结构图像与PET图像融合在一起，以帮助SUV定位。两个PET阅读器独立测量最大SUV。通过将最大SUV标准化为pons SUV（SUVRpons），可获得相对SUV值。横向分类的周期性放电频率既作为分类变量也作为连续量度进行了分析。其他次要变量包括持续时间，幅度，结构性病变的存在以及“加” EEG特征，例如节律性或快速剧烈活动。结果确定了9例患者，其中7例具有LPD的结构病因。使用频率作为分类变量和连续变量的分析显示，LPD频率增加和同侧SUVRpons增加之间存在关联（P = .02）。与LPD相关的代谢（以0.5 Hz为基线）在1 Hz时增加了100％的中值，而对于频率> 1 Hz的频率，增加了309％的中值。在SUVRpons中，其他因素（包括持续时间（P = .10），振幅（P = .80），结构病因（P = .55）或“加”特征（如节律性或快速敏锐活动性（ P = 0.84）。结论代谢活性随LPD频率单调增加。在重症神经疾病中制定神经保护策略时，应定期关注周期性放电频率。中度至重度颅脑外伤后的连续脑电图Lee H，Mizrahi MA，Hartings JA，Sharma S，Pahren L，Ngwenya LB，Moseley BD，Privitera M，Tortella FC，Foreman B.Crit Care Med。2019; 47（4）：574-582。目的在脑外伤后，连续脑电图被广泛用于检测电图发作。随着标准化连续脑电图术语的发展，我们的目的是描述中度至重度脑外伤后电描记性发作的发作间隔和发作频率，并将连续脑电图特征与功能预后相关联。设计对前瞻性，随机对照2期多中心INTREPID研究进行事后分析（ClinicalTrials.gov：NCT00805818）。进入重症监护室后开始进行连续脑电图检查。主要结果是3个月的格拉斯哥成果量表扩展。共识性脑电图检查由对临床数据不了解的标准化连续脑电图术语认证的评估者进行。有节奏，周期性或发作性的模式称为“ 包括创伤性脑损伤国际预后和临床试验分析任务（r = 0.51; P = .01）和损伤严重度评分（r = 0.49; P = 0.01），但不包括功能性结局。在控制了临床协变量后，不良结局独立地与缺乏后方显性节律（常见比值比，3.38； 95％置信区间，1.30-9.09），缺乏N2睡眠瞬态（3.69； 1.69-8.20），主要的三角洲活动（ 2.82; 1.32-6.10），以及在监视的前72小时内不连续的背景（5.33; 2.28-12.96）。结论在本研究的中度至重度颅脑外伤患者中，严重的发作间期连续性模式（包括电图发作）与损伤严重程度的临床指标相关，但与功能预后无关。