title: Generalized periodic discharges in the critically ill: a case-control study of 200 patients.
abstract: OBJECTIVE
  Generalized periodic discharges are increasingly recognized on continuous EEG monitoring, but their relationship to seizures and prognosis remains unclear.
  
  
  METHODS
  All adults with generalized periodic discharges from 1996 to 2006 were matched 1:1 to controls by age, etiology, and level of consciousness. Overall, 200 patients with generalized periodic discharges were matched to 200 controls.
  
  
  RESULTS
  Mean age was 66 years (range 18-96); 56% were comatose. Presenting illnesses included acute brain injury (44%), acute systemic illness (38%), cardiac arrest (15%), and epilepsy (3%). A total of 46% of patients with generalized periodic discharges had a seizure during their hospital stay (almost half were focal), vs 34% of controls (p = 0.014). Convulsive seizures were seen in a third of both groups. A total of 27% of patients with generalized periodic discharges had nonconvulsive seizures, vs 8% of controls (p < 0.001); 22% of patients with generalized periodic discharges had nonconvulsive status epilepticus, vs 7% of controls (p < 0.001). In both groups, approximately half died or were in a vegetative state, one-third had severe disability, and one-fifth had moderate to no disability. Excluding cardiac arrest patients, generalized periodic discharges were associated with increased mortality on univariate analysis (36.8% vs 26.9%; p = 0.049). Multivariate predictors of worse outcome were cardiac arrest, coma, nonconvulsive status epilepticus, and sepsis, but not generalized periodic discharges.
  
  
  CONCLUSIONS
  Generalized periodic discharges were strongly associated with nonconvulsive seizures and nonconvulsive status epilepticus. While nonconvulsive status epilepticus was independently associated with worse outcome, generalized periodic discharges were not after matching for age, etiology, and level of consciousness.
authors.affiliation: Comprehensive Epilepsy Center, Neurological Institute of New York, Columbia University, New York, USA. bf2232@columbia.edu
authors.forename: Brandon
authors.initials: B
authors.lastname: Foreman
authors.forename: Jan
authors.initials: J
authors.lastname: Claassen
authors.forename: Karine
authors.initials: K
authors.lastname: Abou Khaled
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Jirsch
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Alschuler
authors.forename: John
authors.initials: J
authors.lastname: Wittman
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Emerson
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Hirsch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016638:Critical Illness; D004569:Electroencephalography; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology / Q000503:physiopathology*; D018709:Statistics, Nonparametric; D055815:Young Adult