GPDS and NCSE

Foreman BM, Chassen J, Abou Khaled K, et al. Generalized periodic discharges in the critically ill:  a case control study of 200 patients.  Neurology 2012; 79:1951-1960

 

and editorial Jette N, Mosely BD. Generalized periodic discharges : More light shed on the old GPEDs Neurology 2012; 79: 1940-1.

 

Authors found GPD's in 4.5 % of 3000 patients undergoing cEEG.  These 200 patients  had brain injury (44%), acute systemic illness (38%), cardiac arrest (15%) and epilepsy (3%). 

 

27 % of GPD's had NCSE v. 8 % of controls.  However, GPD's were not associated with convulsive seizures. 

 

Authors/editorial notes that the distinction and semiology of GPD's v. triphasic waves is "challenging" even for board certified epileptologists. 

 

Take home messages, per the editorial are:

1) Patients with GPD's on routine EEG should undergo cEEG

2)  NCSE should be promptly treated when diagnosed to prevent mortality

3) Standard terminology and interrater reliability should be assessed within institutional readers.