Abstract
Introduction: It remains controversial whether the periodic discharges (PDs) pattern is an ictal or interictal phenomenon. The aims of the study are to apply time-frequency and power spectrum analysis to study the PDs pattern and prediction of seizures.Methods: We retrospectively searched continuous electroencephalography (cEEG) recordings to identify patients exhibiting the PDs pattern. Artifact-free cEEG segments demonstrating the PDs pattern with stable baselines were chosen for time-frequency and power spectrum analysis.Results: In total, 72 patients (1.3%) exhibited the PDs pattern, with a mean age 36.0 ± 20.7 years (range, 8–76 years). The median spectral power of PDs with a length of 60 s was 70.94 μV2 and that of PDs with a length of 20 s was 195.80 μV2. During follow-up, patients with spectral power of PDs of length 60 and 20 s lower than 28.65 and 36.09 μV2, respectively, exhibited no seizure. For predicting seizures, when the spectral power for PDs of 60 and 20 s equaled to 17.26 and 21.40 μV2, respectively, the diagnostic sensitivity was 100% and specificity was 86%. The locations of maximal spectral power of PDs, crude seizure onset zone (SOZ) judged from scalp EEG, and the most prominent regions of hyper- or hypo-metabolism on FDG-PET were congruent.Conclusions: Spectral power might be a candidate seizure marker of the PDs pattern. High spectral power predicted a high risk of seizures, and low spectral power was associated with a low risk of seizures.
Highlights
It remains controversial whether the periodic discharges (PDs) pattern is an ictal or interictal phenomenon
The participants were outside intensive care unit (ICU), and only 5.6% of them were in a mental state of stupor or coma, whereas, the patients in previous studies were from ICU, and stupor/coma ones accounted for 31–51% of the sample [2, 4]
The current results suggested that spectral power might be used as a candidate seizure marker of the PDs pattern, to identify whether it had enough strength to produce clinical symptoms or not
Summary
It remains controversial whether the periodic discharges (PDs) pattern is an ictal or interictal phenomenon. The periodic discharges (PDs) pattern is an abnormal finding on cEEG, observed in 8.6–14% of critically ill patients [1,2,3,4]. Lateralized PDs reflected severe focal dysfunction and acute destructive processes, and generalized PDs could be related to toxic-metabolic encephalopathies and cerebral hypoxia. Up to now, it has remained controversial whether the PDs pattern is an ictal or an interictal phenomenon [5]. There is no widely agreed-on standard of care for managing patients with PDs pattern epilepsy, and the use of aggressive therapy is still widely debated [5].
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