LAUSR

OBJECTIVE AND BACKGROUND: Significance of Periodic lateralized epileptiform discharges (PLEDs) can be an uncertain abnormality seen on EEG with clinical or subclinical seizures. Treatment of PLEDs in the true clinical setting remains controversial. In this study we analyzed the outcome of patients with acute, chronic and no structural lesions with PLEDs seizures and without seizures. DESIGN/METHODS: This is a retrospective study on 40 patients from an intensive care unit at a single site. We recorded the following parameters: Age, sex, etiology, history of epilepsy , presence of PLED and electrographic seizures on continuous EEG (cEEG) recording, PLEDs treated and untreated , acuity of illness, presence of clinical seizures and presence of acute and chronic structural lesions on neuroimaging. The long term outcome from the medical record was recorded. The most common diagnoses were Status Epilepticus (17), Hypoxic ischemic encephalopathy (10), TBI (4), Metabolic encephalopathy (3), Infectious encephalopathy (2). Less common diagnosis were Acute stroke (1), PRES ( 1), Glioblastoma (1) and metastatic brain lesion (1). RESULTS: Group 1, 35 patients with pleds were treated and group 2, 5 patients with pleds were not treated. Mortality was 43% (group 1) and 40% patients (group 2). Acute structural lesions were found in 11 patients, chronic in 16 and none in 13 patients. All these patients were treated. 45% patients died, 30% discharged Home, 17% nursing home and 7.5% Acute rehab. 45% patients with acute structural lesions died. 31% with chronic lesions died and 62% with no structural lesions died( 5 with HIE, 5 SE, 1 TBI and 1 Acute CVA). CONCLUSIONS: Mortality was unchanged with or without treatment of patients with PLEDs on cEEG, although the extent of treatment was highly variable. PLEDs in the absence of structural lesion can be ictal, interictal or postictal finding on EEG and resulted in a higher mortality rate. Larger, prospective studies that use neuroimaging as part of a decision tree can provide more definitive guidance. Disclosure: Dr. Solaiman has nothing to disclose. Dr. Memon has nothing to disclose. Dr. Basha has nothing to disclose. Dr. Avedian has nothing to disclose.