Abstract
All critically ill patients are prone to neurophysiological stresses that can cause seizures, as well as seizure mimics. In these complex patients, generalized tonic-clonic seizures are rare, but abnormal movements, altered mental status, nonconvulsive seizures, and interictal discharges are far more common. Electroencephalography (EEG) is the key to unlock the answers of these questions. For example, EEG can determine if myoclonus is due to cortical seizure discharges, or because of a metabolic derangement. Continuous EEG (cEEG) can portend improvement or worsening of the patient along the ictal-interictal continuum. The use of trending and quantitative EEG can guide seizure treatment strategies in patients with refractory and super-refractory status epilepticus, and will also help estimate dosages of both acute and long-term antiseizure medication. Complex critically ill patients require complex decision-making tools to diagnose and treat patients with nonconvulsive seizures and nonconvulsive status epilepticus that may be refractory to treatment.
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References
Privitera M, Hoffman M, Moore J, Jester D. EEG detection of nontonic-clonic status epilepticus in patients with altered consciousness. Epilepsy Res. 1994;18(2):155–66. Retrieved 21 May 2020, from https://ncbi.nlm.nih.gov/pubmed/7957038.
Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology. 2004;62(10):1743–8. Retrieved 21 May 2020, from https://ncbi.nlm.nih.gov/pubmed/15159471.
Newey CR, Kinzy TF, Punia V, Hantus S. Continuous electroencephalography in the critically ill: clinical and continuous electroencephalography markers for targeted monitoring. J Clin Neurophysiol. 2018;35(4):325–31.
Beniczky S, Hirsch LJ, Kaplan PW, Pressler R, Bauer G, Auerlien H, Brogger JC, Trinka E. Unified EEG terminology and criteria for nonconvulsive status epilepticus. Epilepsia. 2013;54(Suppl. 6):28–9.
Hirsch LJ, LaRoche SM, Gaspard N, Gerard E, Svoronos A, Herman S, Mani R, Arif H, Jette N, Minazad Y, Kerrigan J, Vestpa P, Hantus S, Claassen J, Young GB, So E, Kaplan PW, Nuwer MR, Fountain NB, Drislane FW. American Clinical Neurophysiology Society’s standardized critical care EEG terminology: 2012 version. J Clin Neurophysiol. 2013;30:1–27.
Rubinos C, Reynolds AS, Claassen J. The Ictal-Interictal continuum: to treat of not to treat (and how)? Nuerocrit Care. 2018;29:3–8.
Kantanen AM, Reinikainen M, Parviainen I, Ruokonen E, Ala-Peijari M, Backlund T, Koskenkari J, Laitio R, Kalvaiainen R. Incidence and mortality of super-refractory status epilepticus in adults. Epilepsy Behav. 2015;49:1313–4.
Cervenka MC, Hocker S, Koenig M, Bar B, Henry-Barron B, Kossoff EH, Hargman A, Probasco JC, Benavides D, Venkatesan A, Hagen EC, Dittrich D, Stern T, Radzik B, Depew M, Caserta FM, Nyquist P, Kaplan PW, Geocadin RG. Phase I/II multicenter ketogenic diet study for adult superrefractory status epilepticus. Neurology. 2017;88(10):938–43.
Shah Z, Moran BP, McKinney AM, Henry TR. Seizure outcomes of posterior reversible encephalopathy syndrome and correlations with electroencephalographic changes. Epilepsy Behav. 2015;48:70–4.
Kastrup O, Gerwig M, Frings M, Diener HC. Posterior reversible encephalopathy syndrome (PRES): electroencephalographic findings and seizure patterns. J Neurol. 2012;259:1383–9.
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Siegel, J., Freeman, W.D. (2021). Seizures in the Intensive Care Unit. In: Tatum, W.O., Sirven, J.I., Cascino, G.D. (eds) Epilepsy Case Studies. Springer, Cham. https://doi.org/10.1007/978-3-030-59078-9_20
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DOI: https://doi.org/10.1007/978-3-030-59078-9_20
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