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

Li, Han-Tao; Wu, Tony; Lin, Wey‐Ran; Tseng, Wei‐En Johnny; Chang, Chun-Wei; Cheng, Meng-Hsuan; Hsieh, Hsiang‐Yao; Chiang, Hsing-I; Lee, Chih-Hong; Chang, Bao‐Luen; Lim, Siew‐Na

doi:10.1016/j.eplepsyres.2017.02.004

Cited by 20 publications

(34 citation statements)

References 32 publications

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“…Lateralized patterns (LPD (+), LRDA (+s)) can occur in the setting of focal CNS lesions; while acute stroke is reported as the most common etiology for LPDs, LRDA has most commonly been observed in intracerebral and subarachnoid hemorrhages . Interestingly, lateralized patterns occurred contralateral to the site of EVD placement and no other focal lesions (hemorrhagic or ischemic) were found ipsilateral to these patterns in our patient cases.…”

Section: Discussionmentioning

confidence: 59%

Seizures, periodic and rhythmic patterns in primary intraventricular hemorrhage

Stretz

Sheikh

Maciel

et al. 2018

Ann Clin Transl Neurol

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ObjectivePrimary intraventricular hemorrhage (pIVH) uncommonly presents with seizures. There are no prior data regarding the frequency of seizures, periodic and rhythmic patterns on continuous electroencephalography (EEG), (cEEG) in these patients.MethodsWe retrospectively assessed frequency of seizures, periodic discharges, and rhythmic patterns in pIVH patients undergoing cEEG monitoring. We reviewed indications for cEEG, demographics, GCS at presentation and during cEEG, modified Graeb score (mGS), presence of hydrocephalus, cEEG duration, findings and use of antiseizure medications (ASM). cEEG patterns were classified according to location and morphology. All patterns were considered “hyperexcitable” except GRDA. The ictal‐interictal continuum (IIC) was defined as LRDA, PDs, and/or SW >1 Hz but <2.5 Hz, not meeting criteria for definite electrographic seizures.ResultsEleven patients had pIVH with median age of 81 (46–87) years and median mGS of 15 (9–23). Hydrocephalus was present in 7 (63.6%) and all underwent external ventricular drain (EVD) placement. Median cEEG recording was 19 (12–156) hours. Periodic or rhythmic EEG patterns were seen in 7 of 11 (64%), 5 of which were “hyperexcitable”. For the 5 patients with pIVH, EVDs, and hyperexcitable patterns, 4 (80%) were lateralized contralateral to the EVD and 1 (20%) was generalized to the EVD. The only significant difference between the hyperexcitable and non‐hyperexcitable group was duration of cEEG monitoring (P = 0.007).InterpretationHyperexcitable patterns were common in our cases. Further research is warranted to assess prevalence of hyperexcitable patterns, their risk factors, underlying pathophysiology, and association with neuronal injury in pIVH.

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Section: Discussionmentioning

confidence: 59%

Seizures, periodic and rhythmic patterns in primary intraventricular hemorrhage

Stretz

Sheikh

Maciel

et al. 2018

Ann Clin Transl Neurol

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“…21 Electrographic seizures could lead to a steady neurological decline and an increase in seizure burden. 21,22 Prolonged nonconvulsive seizures could be an epiphenomenon of an underlying serious brain injury that progressed to neurological deterioration and irreversible brain damage. 21,22 Li et al proved that periodic discharges were related to clinical seizures in 67% cases.…”

Section: Periodic Discharges In Status Epilepticusmentioning

confidence: 99%

“…21,22 Prolonged nonconvulsive seizures could be an epiphenomenon of an underlying serious brain injury that progressed to neurological deterioration and irreversible brain damage. 21,22 Li et al proved that periodic discharges were related to clinical seizures in 67% cases. 22 Electrographic seizures were associated with unfavorable functional out comes and worsening of the underlying neurological condition.…”

Section: Periodic Discharges In Status Epilepticusmentioning

confidence: 99%

“…21,22 Li et al proved that periodic discharges were related to clinical seizures in 67% cases. 22 Electrographic seizures were associated with unfavorable functional out comes and worsening of the underlying neurological condition. 22 Bilateral independent periodic discharges evolving to generalized periodic discharges were treated with firstline antiepileptics as there was a strong correlation with status epilepticus.…”

Section: Periodic Discharges In Status Epilepticusmentioning

confidence: 99%

“…22 Electrographic seizures were associated with unfavorable functional out comes and worsening of the underlying neurological condition. 22 Bilateral independent periodic discharges evolving to generalized periodic discharges were treated with firstline antiepileptics as there was a strong correlation with status epilepticus. 21,22 Long-term outcome of periodic discharges depended on the neurological diagnosis, comorbidities, and the age of the patients.…”

Section: Periodic Discharges In Status Epilepticusmentioning

confidence: 99%

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Concepts in Periodic Discharges: A Descriptive Study

Khanna

Agarwal

Kandel

2018

International Journal of Epilepsy

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Introduction Periodic discharges are now known as the ictal–interictal continuum and represent ongoing injury in acute or chronic neurological illnesses. Objective The aim of our study was to identify periodic discharges in patients who have undergone continuous bedside electroencephalography (EEG) monitoring and to classify the EEG according to the current American Clinical Neurophysiology Society terminology. Materials and Methods The continuous bedside EEG records of intensive care patients admitted from August 2017 to July 2018 were analyzed. The clinical spectrum, the treatment, and outcome of each of these patients were monitored. Results Fifty cases of periodic discharges (11 children, 39 adults) were identified over 1 year from 2017 to 2018. The clinical presentation included 32% seizures, 16% status epilepticus, 20% coma, 16% fever with altered sensorium, 8% abnormal behavior, 4% strokes, and 4% traumatic brain injury. The diagnosis was 20% autoimmune encephalitis, 8% herpes encephalitis, 20% multiorgan failure, 4% traumatic brain injury, 16% status epilepticus, 16% posthypoxic encephalopathy, 4% strokes, 4% intracerebral bleeds, 4% meningitis, and 4% severe dementia. Lateralized periodic discharges were identified in 20%, bilateral independent periodic discharges in 20%, and generalized periodic discharges in 60%. Fifty-six percent patients recovered with residual neurological deficits and 44% succumbed to their illness. Conclusions Continuous bedside EEG monitoring has revolutionized the approach to seizures in critically ill patients. Despite a vigilant approach and diligent diagnosis of these abnormal rhythms, the mortality rate was 20% in patients with lateralized periodic discharges and 60% with bilateral and generalized periodic discharges (p ≤ 0.05).

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Common Abnormal EEG in Neurocritical Ill Patients

Wang

et al. 2021

Multi-Modal EEG Monitoring of Severely Neurologically Ill Patients

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

Abstract: PDs were associated with high rates of comorbidities and recent seizures, while the use of antiepileptic drugs was associated with a lower rate of mortality.

Cited by 20 publications

References 32 publications

Seizures, periodic and rhythmic patterns in primary intraventricular hemorrhage

Seizures, periodic and rhythmic patterns in primary intraventricular hemorrhage

Concepts in Periodic Discharges: A Descriptive Study

Common Abnormal EEG in Neurocritical Ill Patients

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