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Clinical and imaging correlates of lateralized rhythmic delta activity: A multicenter cohort study
Sophia Muqaddas1, Zade Akras1, Kaileigh Gallagher2
1Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Objective:
Determine the clinical and imaging correlates and outcomes of lateralized rhythmic delta activity (LRDA).
Methods:
Multicenter retrospective study of hospitalized patients (age ≥ 18) undergoing continuous EEG. Rhythmic and periodic patterns (RPPs) including LRDA, lateralized and generalized periodic discharges (LPDs, GPDs) were extracted from EEG reports.
Results:
Among 3163 adults, LRDA occurred in 199 (6.3%); 137 (68.8%) had isolated LRDA and 62 (31.2%) had LRDA with other RPPs. Patients with LRDA were more likely to have LPDs compared to patients without LRDA (27.6% vs 6.8%; p < 0.001). LRDA was associated with frontal lobe involvement (OR = 2.17, p < 0.001) and structural abnormalities including tumor/mass (OR = 3.89, p < 0.001), hemorrhage (OR = 2.19, p < 0.001), stroke (OR = 1.73, p = 0.025). On adjusted analysis RPPs were associated with EEG seizures as follows: isolated LRDA (OR = 4.97; p < 0.001), other RPPs (OR = 6.19; p < 0.001), LRDA + other RPPs (OR = 15.50; p < 0.001). Associations with discharge modified Rankin Scale 4-6 were as follows: isolated LRDA (OR = 1.53; p = 0.062), other RPPs (OR = 2.87; p < 0.001), LRDA + other RPPs (OR = 6.99; p = 0.002).
Conclusion:
Presence of LRDA correlates with frontal lobe involvement and structural pathologies. While isolated LRDA is associated with seizures, it was not associated with poor outcomes.
Significance:
Future studies are indicated to determine whether differential treatment is warranted for isolated LRDA vs. LRDA with other RPPs.