Bilateral independent periodic discharges are associated with electrographic seizures and poor outcome: a case-control study

Publication date: Available online 29 August 2018

Source: Clinical Neurophysiology

Author(s): Gamaleldin Osman, Rahul Rahangdale, Jeffrey W. Britton, Emily J. Gilmore, Hiba Arif Haider, Stephen Hantus, Aline Herlopian, Sara E. Hocker, Jong Woo Lee, Benjamin Legros, Michael Mendoza, Vineet Punia, Nishi Rampal, Jerzy P. Szaflarski, Adam D. Wallace, M. Brandon Westover, Lawrence J. Hirsch, Nicolas Gaspard

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.

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