Continuous electroencephalography in the medical intensive care unit*

Abstract

In this retrospective study of MICU patients monitored with cEEG, ESZs and PEDs were frequent, predominantly in patients with sepsis. Seizures were mainly nonconvulsive. Both seizures and periodic discharges were associated with poor outcome. Prospective studies are warranted to determine more precisely the frequency and clinical impact of nonconvulsive seizures and periodic discharges, particularly in septic patients.

The Utility of EEG, SSEP, and Other Neurophysiologic Tools to Guide Neurocritical Care

“…In a convenience sample of patients with head trauma, spontaneous hemorrhage, or brain tumor within a neurosurgical unit, 28 of 158 patients had nonconvulsive status epilepticus on EEG, but 40% of the patients with nonconvulsive status epilepticus had a Glasgow Coma Scale score ≥9 [56]. Similarly, in patients with sepsis found to have seizures, the presence of coma was not associated with a significant difference in the prevalence of electrographic seizures or periodic discharges (24% among comatose patients and 20% among noncomatose patients) [54].…”

“…Neurological complications more than double length of stay in the medical intensive care environment, with sepsis a particularly potent cause of epileptic encephalopathy. Among a cohort of patients monitored by EEG in a medical intensive care unit, the rate of electrographic seizures or periodic discharges was more than triple among patients with sepsis compared with those without (32% vs 9%), a characteristic of independent risk that was more significant than a history of epilepsy or clinical seizures suspected prior to the initiation of monitoring [54]. A number of medical diseases causing mental status changes are increasingly being appreciated for a direct neurological mechanism by which seizures mediate a previously regarded "medical" encephalopathy, such as that in patients with thrombotic thrombocytopenic purpura [55].…”

Quantitative EEG for the Detection of Brain Ischemia

“…Titration of vasopressors may be infl uenced by the detection of ischemic changes despite an otherwise appropriate mean arterial pressure (MAP) goal. Although recent studies of EEG in patients with sepsis have focused on seizure detection and other abnormal epileptiform patterns [40], quantifi cation of cerebral perfusion in these patients could be an invaluable measure of end-organ perfusion to guide pressor management, particularly in patients with sepsis-associated encephalopathy, which may be related to impaired perfusion of the small vessels [41]. SAH provides a useful example to illustrate the need for and potential of existing data related to qEEG techniques in the ICU.…”

Continuous Electroencephalography in the Medical ICU

“…A recently published study by Oddo et al [4] from Columbia University contributes to fill this gap in our knowledge. The investigators reviewed the data of 201 consecutive patients who underwent cEEG monitoring in their medical ICU.…”