Clinical correlation and prognostic implication of periodic EEG patterns: A cohort study

- Periodic discharges (PDs) were associated with high rates of comorbidities and mortality.
- Old age was the strongest predictor of mortality in patients with PDs.
- Prompt use of antiepileptic drugs might prevent poor outcome in patients with PDs.
- Cefepime encephalopathy should be considered in patients with PDs.

ObjectiveDespite increasing amounts of research on periodic discharges (PDs), large clinical studies regarding their prognostic value are lacking. The aim of the current study was to evaluate the clinical implications and prognostic value of PDs.MethodsIn this single-center retrospective cohort study, we included patients who underwent electroencephalographic recording either during hospitalization or from our outpatient clinics. Demographic data, associated seizure events, use of antiepileptic drugs, and outcomes at discharge were analyzed. Multivariate logistic regression analysis was used to evaluate associations between clinical factors and functional outcomes.ResultsFour hundred and twenty patients were enrolled during a 17-year period, with a mean age of 66 years. The main etiologies included systemic infection (24%), anoxia (15%), and ischemic stroke (12%). Recent seizures were identified in 283 patients (67%), of whom 84 (30%) had status epilepticus. One hundred and fifty-four patients (37%) did not survive to hospital discharge. In multivariate analysis, old age (>65 years; OR = 2.55; 95% CI = 1.57-4.16; P < 0.001) was the strongest predictor of mortality, followed by systemic infection, anoxic encephalopathy, cefepime encephalopathy, and the occurrence of status epilepticus. Conversely, the use of antiepileptic drugs was negatively associated with mortality (OR = 0.50; 95% CI = 0.28-0.87; P = 0.02).ConclusionsPDs were associated with high rates of comorbidities and recent seizures, while the use of antiepileptic drugs was associated with a lower rate of mortality.