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Bilateral independent periodic lateralized epileptiform discharges. Clinical significance
Insights
Bilateral independent periodic lateralized epileptiform discharges (BIPLEDs) are linked to higher mortality and coma compared to periodic lateralized epileptiform discharges (PLEDs). Causes differ, with stroke common in PLEDs and anoxic encephalopathy or CNS infection prevalent in BIPLEDs.
Area of Science:
- Neurology
- Neurophysiology
- Clinical Neuroscience
Background:
- Periodic lateralized epileptiform discharges (PLEDs) are EEG patterns associated with various acute brain injuries.
- Bilateral independent periodic lateralized epileptiform discharges (BIPLEDs) represent a distinct EEG pattern with potentially different underlying etiologies and prognoses.
Purpose of the Study:
- To compare the clinical characteristics, etiologies, and outcomes of patients with BIPLEDs versus PLEDs.
- To identify factors differentiating BIPLEDs from PLEDs in a clinical setting.
Main Methods:
- Retrospective review of clinical data from 18 patients with BIPLEDs.
- Comparison of BIPLEDs cohort with 45 patients diagnosed with PLEDs.
- Analysis of EEG findings, clinical presentation, neuroimaging, and patient outcomes.
Main Results:
- Anoxic encephalopathy (28%) and central nervous system (CNS) infection (28%) were leading causes of BIPLEDs, whereas recent stroke was most common for PLEDs (33%).
- Coma predominated in BIPLEDs (72%) compared to PLEDs (24%).
- Mortality rates were significantly higher in the BIPLEDs group (61%) versus the PLEDs group (29%).
Conclusions:
- BIPLEDs are associated with distinct etiologies, including anoxic encephalopathy and CNS infections, and a poorer prognosis than PLEDs.
- Patients with BIPLEDs frequently present with coma and experience higher mortality rates.
- Differentiating BIPLEDs from PLEDs is crucial for understanding underlying pathology and predicting patient outcomes.
Abstract:
Clinical data on 18 patients whose EEGs showed bilateral independent periodic lateralized epileptiform discharges (BIPLEDs) were reviewed and compared with those of 45 patients with periodic lateralized epileptiform discharges (PLEDs). A recent stroke was the most frequent cause of PLEDs (33%), while anoxic encephalopathy (28%) and CNS infection (28%) accounted for the majority of BIPLEDs. Focal neurologic deficits, focal seizures, and focal computed tomographic scan abnormalities were frequent in those with PLEDs, while coma predominated in the group with BIPLEDs (72% vs 24%). Mortality was also higher in patients with BIPLEDs--61% vs 29%.