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Which EEG Patterns Deserve Treatment in the ICU?

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Clinical Neurophysiology in Disorders of Consciousness
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Abstract

Paroxysmal and periodic patterns on continuously recorded EEG are commonly seen in the neurocritical care setting. As these patterns span the nonepileptic, interictal, postictal, and ictal continuum, accurate identification and appropriate management may present major challenges. This chapter will survey the most commonly seen EEG features, including sharp waveforms, rhythmic waves, lateralized and generalized periodic discharges, and subclinical seizures. To date, evidence-based guidelines for the management of these patterns are lacking; reasonable approaches to their management will be presented. Where continuous EEG monitoring is available, a stepwise approach with close follow-up of these uncertain EEG features may be reasonable in a large number of these cases.

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References

  • Accolla EA, Kaplan PW et al (2011) Clinical correlates of frontal intermittent rhythmic delta activity (FIRDA). Clin Neurophysiol 122(1):27–31

    Article  PubMed  Google Scholar 

  • Adachi N, Kanemoto K et al (2005) Intellectual prognosis of status epilepticus in adult epilepsy patients: analysis with Wechsler Adult Intelligence Scale-revised. Epilepsia 46(9):1502–1509

    Article  PubMed  Google Scholar 

  • Alvarez V, Oddo M et al (2013) Stimulus-induced rhythmic, periodic or ictal discharges (SIRPIDs) in comatose survivors of cardiac arrest: characteristics and prognostic value. Clin Neurophysiol 124(1):204–8

    Article  PubMed  Google Scholar 

  • Assal F, Papazyan JP et al (2001) SPECT in periodic lateralized epileptiform discharges (PLEDs): a form of partial status epilepticus? Seizure 10(4):260–265

    Article  CAS  PubMed  Google Scholar 

  • Bauer G, Trinka E (2010) Nonconvulsive status epilepticus and coma. Epilepsia 51(2):177–190

    Article  PubMed  Google Scholar 

  • Brenner RP, Schaul N (1990) Periodic EEG patterns: classification, clinical correlation, and pathophysiology. J Clin Neurophysiol 7(2):249–267

    Article  CAS  PubMed  Google Scholar 

  • Brigo F (2011) Intermittent rhythmic delta activity patterns. Epilepsy Behav 20(2):254–256

    Article  PubMed  Google Scholar 

  • Carrera E, Michel P et al (2006) Continuous assessment of electrical epileptic activity in acute stroke. Neurology 67(1):99–104

    Article  CAS  PubMed  Google Scholar 

  • Chong DJ, Hirsch LJ (2005) Which EEG patterns warrant treatment in the critically ill? Reviewing the evidence for treatment of periodic epileptiform discharges and related patterns. J Clin Neurophysiol 22(2):79–91

    Article  PubMed  Google Scholar 

  • Claassen J, Mayer SA et al (2004) Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology 62(10):1743–1748

    Article  CAS  PubMed  Google Scholar 

  • Claassen J, Jette N et al (2007) Electrographic seizures and periodic discharges after intracerebral hemorrhage. Neurology 69(13):1356–1365

    Article  CAS  PubMed  Google Scholar 

  • Cobb WA (1945) Rhythmic slow discharges in the electroencephalogram. J Neurol Neurosurg Psychiatry 8:65–78

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Cobb W, Hill D (1950) Electroencephalogram in subacute progressive encephalitis. Brain 73(3):392–404

    Article  CAS  PubMed  Google Scholar 

  • Cobb WA, Guiloff RJ et al (1979) Breach rhythm: the EEG related to skull defects. Electroencephalogr Clin Neurophysiol 47(3):251–271

    Article  CAS  PubMed  Google Scholar 

  • Crepeau AZ, Rabinstein AA et al (2013) Continuous EEG in therapeutic hypothermia after cardiac arrest: prognostic and clinical value. Neurology 80(4):339–344

    Article  PubMed  Google Scholar 

  • de la Paz D, Brenner RP (1981) Bilateral independent periodic lateralized epileptiform discharges. Clinical significance. Arch Neurol 38(11):713–715

    Article  PubMed  Google Scholar 

  • Drislane FW (2006) Who’s afraid of status epilepticus? Epilepsia 47(1):7–9

    Article  PubMed  Google Scholar 

  • Ergun EL, Salanci BV et al (2006) SPECT in periodic lateralized epileptiform discharges (PLEDs): a case report on PLEDs. Ann Nucl Med 20(3):227–231

    Article  PubMed  Google Scholar 

  • Fitzpatrick W, Lowry N (2007) PLEDs: clinical correlates. Can J Neurol Sci 34(4):443–450

    Article  CAS  PubMed  Google Scholar 

  • Foreman B, Claassen J et al (2012) Generalized periodic discharges in the critically ill: a case-control study of 200 patients. Neurology 79(19):1951–1960

    Article  PubMed Central  PubMed  Google Scholar 

  • Garzon E, Fernandes RM et al (2001) Serial EEG during human status epilepticus: evidence for PLED as an ictal pattern. Neurology 57(7):1175–1183

    Article  CAS  PubMed  Google Scholar 

  • Gaspard N, Manganas L et al (2013) Similarity of lateralized rhythmic delta activity to periodic lateralized epileptiform discharges in critically ill patients. JAMA Neurol 70(10):1288–1295

    PubMed  Google Scholar 

  • Gullapalli D, Fountain NB (2003) Clinical correlation of occipital intermittent rhythmic delta activity. J Clin Neurophysiol 20(1):35–41

    Article  PubMed  Google Scholar 

  • Handforth A, Cheng JT et al (1994) Markedly increased mesiotemporal lobe metabolism in a case with PLEDs: further evidence that PLEDs are a manifestation of partial status epilepticus. Epilepsia 35(4):876–881

    Article  CAS  PubMed  Google Scholar 

  • Herskovitz M, Schiller Y (2012) Prolonged ictal aphasia: a diagnosis to consider. J Clin Neurosci 19(11):1605–1606

    Article  PubMed  Google Scholar 

  • Hirsch LJ, Claassen J et al (2004) Stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs): a common EEG phenomenon in the critically ill. Epilepsia 45(2):109–123

    Article  PubMed  Google Scholar 

  • Hirsch LJ, LaRoche SM et al (2013) American Clinical Neurophysiology Society’s Standardized Critical Care EEG Terminology: 2012 version. J Clin Neurophysiol 30(1):1–27

    Article  CAS  PubMed  Google Scholar 

  • Hughes JR (2010) Periodic lateralized epileptiform discharges: do they represent an ictal pattern requiring treatment? Epilepsy Behav 18(3):162–165

    Article  PubMed  Google Scholar 

  • Husain AM, Mebust KA et al (1999) Generalized periodic epileptiform discharges: etiologies, relationship to status epilepticus, and prognosis. J Clin Neurophysiol 16(1):51–58

    Article  CAS  PubMed  Google Scholar 

  • Jirsch J, Hirsch LJ (2007) Nonconvulsive seizures: developing a rational approach to the diagnosis and management in the critically ill population. Clin Neurophysiol 118(8):1660–1670

    Article  CAS  PubMed  Google Scholar 

  • Jordan KG (1992) Nonconvulsive seizures (NCS) and nonconvulsive status epilepticus (NCSE) detected by continuous EEG monitoring in the neuro ICU. Neurology 42(Suppl 3):194–195

    Google Scholar 

  • Kaplan PW (2007) EEG criteria for nonconvulsive status epilepticus. Epilepsia 48(Suppl 8):39–41

    Article  PubMed  Google Scholar 

  • Lee JW, Tanaka N et al (2010) Evaluation of postoperative sharp waveforms through EEG and magnetoencephalography. J Clin Neurophysiol 27(1):7–11

    Article  PubMed  Google Scholar 

  • Legriel S, Hilly-Ginoux J et al (2013) Prognostic value of electrographic postanoxic status epilepticus in comatose cardiac-arrest survivors in the therapeutic hypothermia era. Resuscitation 84(3):343–350

    Article  PubMed  Google Scholar 

  • Lucas JM, Cocchi MN et al (2012) Neurologic recovery after therapeutic hypothermia in patients with post-cardiac arrest myoclonus. Resuscitation 83(2):265–269

    Article  PubMed  Google Scholar 

  • Mani R, Schmitt SE et al (2012) The frequency and timing of epileptiform activity on continuous electroencephalogram in comatose post-cardiac arrest syndrome patients treated with therapeutic hypothermia. Resuscitation 83(7):840–847

    Article  PubMed  Google Scholar 

  • Markand ON (2003) Pearls, perils, and pitfalls in the use of the electroencephalogram. Semin Neurol 23(1):7–46

    Article  PubMed  Google Scholar 

  • Murahara T, Kinoshita M et al (2013) Prolonged ictal monoparesis with parietal Periodic Lateralised Epileptiform Discharges (PLEDs). Epileptic Disord 15(2):197–202

    PubMed  Google Scholar 

  • Naidech AM, Kreiter KT et al (2005) Phenytoin exposure is associated with functional and cognitive disability after subarachnoid hemorrhage. Stroke 36(3):583–587

    Article  CAS  PubMed  Google Scholar 

  • Normand MM, Wszolek ZK et al (1995) Temporal intermittent rhythmic delta activity in electroencephalograms. J Clin Neurophysiol 12(3):280–284

    Article  CAS  PubMed  Google Scholar 

  • Orta DS, Chiappa KH et al (2009) Prognostic implications of periodic epileptiform discharges. Arch Neurol 66(8):985–991

    PubMed  Google Scholar 

  • Privitera M, Hoffman M et al (1994) EEG detection of nontonic-clonic status epilepticus in patients with altered consciousness. Epilepsy Res 18(2):155–166

    Article  CAS  PubMed  Google Scholar 

  • Reiher J, Beaudry M et al (1989) Temporal intermittent rhythmic delta activity (TIRDA) in the diagnosis of complex partial epilepsy: sensitivity, specificity and predictive value. Can J Neurol Sci 16(4):398–401

    CAS  PubMed  Google Scholar 

  • Reiher J, Rivest J et al (1991) Periodic lateralized epileptiform discharges with transitional rhythmic discharges: association with seizures. Electroencephalogr Clin Neurophysiol 78(1):12–17

    Article  CAS  PubMed  Google Scholar 

  • Rittenberger JC, Popescu A et al (2012) Frequency and timing of nonconvulsive status epilepticus in comatose post-cardiac arrest subjects treated with hypothermia. Neurocrit Care 16(1):114–122

    Article  PubMed Central  PubMed  Google Scholar 

  • Rossetti AO, Oddo M (2010) The neuro-ICU patient and electroencephalography paroxysms: if and when to treat. Curr Opin Crit Care 16(2):105–109

    Article  PubMed  Google Scholar 

  • Rossetti AO, Hurwitz S et al (2006) Prognosis of status epilepticus: role of aetiology, age, and consciousness impairment at presentation. J Neurol Neurosurg Psychiatry 77(5):611–615

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Rossetti AO, Logroscino G et al (2007) Status epilepticus: an independent outcome predictor after cerebral anoxia. Neurology 69(3):255–260

    Article  CAS  PubMed  Google Scholar 

  • Rossetti AO, Oddo M et al (2009) Predictors of awakening from postanoxic status epilepticus after therapeutic hypothermia. Neurology 72(8):744–749

    Article  PubMed  Google Scholar 

  • Rundgren M, Westhall E et al (2010) Continuous amplitude-integrated electroencephalogram predicts outcome in hypothermia-treated cardiac arrest patients. Crit Care Med 38(9):1838–1844

    Article  PubMed  Google Scholar 

  • Singh G, Wright MA et al (2005) Periodic lateralized epileptiform discharges (PLEDs) as the sole electrographic correlate of a complex partial seizure. Epileptic Disord 7(1):37–41

    PubMed  Google Scholar 

  • Snodgrass SM, Tsuburaya K et al (1989) Clinical significance of periodic lateralized epileptiform discharges: relationship with status epilepticus. J Clin Neurophysiol 6(2):159–172

    Article  CAS  PubMed  Google Scholar 

  • Vespa PM, Miller C et al (2007) Nonconvulsive electrographic seizures after traumatic brain injury result in a delayed, prolonged increase in intracranial pressure and metabolic crisis. Crit Care Med 35(12):2830–2836

    Article  PubMed  Google Scholar 

  • Vespa PM, McArthur DL et al (2010) Nonconvulsive seizures after traumatic brain injury are associated with hippocampal atrophy. Neurology 75(9):792–798

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Westmoreland BF, Klass DW et al (1986) Chronic periodic lateralized epileptiform discharges. Arch Neurol 43(5):494–496

    Article  CAS  PubMed  Google Scholar 

  • Wijdicks EF, Parisi JE et al (1994) Prognostic value of myoclonus status in comatose survivors of cardiac arrest. Ann Neurol 35(2):239–243

    Article  CAS  PubMed  Google Scholar 

  • Yemisci M, Gurer G et al (2003) Generalised periodic epileptiform discharges: clinical features, neuroradiological evaluation and prognosis in 37 adult patients. Seizure 12(7):465–472

    Article  PubMed  Google Scholar 

  • Young GB, Jordan KG et al (1996) An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology 47(1):83–89

    Article  CAS  PubMed  Google Scholar 

  • Zeiler SR, Turtzo LC et al (2011) SPECT-negative SIRPIDs argues against treatment as seizures. J Clin Neurophysiol 28(5):493–496

    PubMed  Google Scholar 

  • Zurek R, Schiemann Delgado J et al (1985) Frontal intermittent rhythmical delta activity and anterior bradyrhythmia. Clin Electroencephalogr 16(1):1–10

    CAS  PubMed  Google Scholar 

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Correspondence to Jong Woo Lee MD, PhD .

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Lee, J.W. (2015). Which EEG Patterns Deserve Treatment in the ICU?. In: Rossetti, A., Laureys, S. (eds) Clinical Neurophysiology in Disorders of Consciousness. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1634-0_3

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  • DOI: https://doi.org/10.1007/978-3-7091-1634-0_3

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