“Ictal” lateralized periodic discharges

Sen‐Gupta, Indranil; Schuele, Stephan; Macken, Mícheál P.; Kwasny, Mary; Gerard, Elizabeth E.

doi:10.1016/j.yebeh.2014.05.014

Cited by 27 publications

(18 citation statements)

References 20 publications

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“…In unselected patients undergoing EEG (including outpatients), the prevalence of LPDs is 0.4–1% (Fitzpatrick and Lowry, 2007, Pohlmann-Eden et al, 1996). In hospitalized patients undergoing continuous EEG monitoring, the prevalence is 6.2%–8.6% (Lee et al, 2016, Sen-Gupta et al, 2014, Swisher et al, 2015). Periodic patterns tend to flock together: LPDs are also seen in 21.5% of patients with generalized periodic discharges (GPDs) undergoing prolonged cEEG monitoring (Foreman et al, 2012).…”

Section: Lateralized Periodic Discharges (Lpds)mentioning

confidence: 99%

“…The question of whether LPDs themselves represent ictal patterns is debated; when focal twitching or movements are time-locked to a discharge, LPDs are considered ictal (Walsh and Brenner, 1987); clear focal motor seizures including epilepsia partialis continua (EPC) may be time- and location-correlated to observed LPDs (Fitzpatrick and Lowry, 2007). However, in a study of with and without motor manifestations, Sen-Gupta et al found that LPDs with associated motor findings were more likely to arise from central head regions, and concluded that motor findings are not a reliable determinant of whether LPDs are “ictal” or “non-ictal.” They argue that LPDs occurring in other locations would be expected to have other clinical manifestations (such as confusion or aphasia), or to be asymptomatic (Sen-Gupta et al, 2014), and that LPDs without motor manifestations may also be ictal patterns.…”

Section: Lateralized Periodic Discharges (Lpds)mentioning

confidence: 99%

“…The mortality of patients with LPDs ranges from 24–41% (Fitzpatrick and Lowry, 2007, San juan Orta et al, 2009, Walsh and Brenner, 1987), with a “poor” outcome in 68% (Sen-Gupta et al, 2014) and only 21% achieving independent functional status after 1 year (San juan Orta et al, 2009). …”

Section: Lateralized Periodic Discharges (Lpds)mentioning

confidence: 99%

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Population of the ictal-interictal zone: The significance of periodic and rhythmic activity

Johnson

Kaplan

2017

Clinical Neurophysiology Practice

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Section: Lateralized Periodic Discharges (Lpds)mentioning

confidence: 99%

Section: Lateralized Periodic Discharges (Lpds)mentioning

confidence: 99%

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Population of the ictal-interictal zone: The significance of periodic and rhythmic activity

Johnson

Kaplan

2017

Clinical Neurophysiology Practice

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“…16 It has been debated for decades whether PLEDs are ictal or interictal. Those who argue that PLEDs are ictal point to the clinical correlates of PLEDs, such as motor, sensory, and cognitive changes, 17 or to the presence of focal glucose hypermetabolism on positron emission tomography (PET) 18 and focal hyperperfusion on single-photon emission computed tomography (SPECT), 19 not to mention the resolution of these findings when PLEDs disappear. Nonetheless, some studies have shown that focal hypermetabolism and/or hyperperfusion may also occur during focal interictal spikes.…”

Section: Introductionmentioning

confidence: 99%

Periodic lateralized epileptiform discharges can survive anesthesia and result in asymmetric drug-induced burst suppression

et al. 2017

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Drug-induced burst suppression (DIBS) is bihemispheric and bisymmetric in adults and older children. However, asymmetric DIBS may occur if a pathological process is affecting one hemisphere only or both hemispheres disproportionately. The usual suspect is a destructive lesion; an irritative or epileptogenic lesion is usually not invoked to explain DIBS asymmetry. We report the case of a 66-year-old woman with new-onset seizures who was found to have a hemorrhagic cavernoma and periodic lateralized epileptiform discharges (PLEDs) in the right temporal region. After levetiracetam and before anesthetic antiepileptic drugs (AEDs) were administered, the electroencephalogram (EEG) showed continuous PLEDs over the right hemisphere with maximum voltage in the posterior temporal region. Focal electrographic seizures also occurred occasionally in the same location. Propofol resulted in bihemispheric, but not in bisymmetric, DIBS. Remnants or fragments of PLEDs that survived anesthesia increased the amplitude and complexity of the bursts in the right hemisphere leading to asymmetric DIBS. Phenytoin, lacosamide, ketamine, midazolam, and topiramate were administered at various times in the course of EEG monitoring, resulting in suppression of seizures but not of PLEDs. Ketamine and midazolam reduced the rate, amplitude, and complexity of PLEDs but only after producing substantial attenuation of all burst components. When all anesthetics were discontinued, the EEG reverted to the original preanesthesia pattern with continuous non-fragmented PLEDs. The fact that PLEDs can survive anesthesia and affect DIBS symmetry is a testament to the robustness of the neurodynamic processes underlying PLEDs.

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“…21,22 They are, however, the most commonly observed periodic pattern in critically ill patients, seen in 6.1 to 8.6% of hospitalized patients. [23][24][25][26] When Do We See Them?…”

Section: Lateralized Periodic Dischargesmentioning

confidence: 99%

Ictal-Interictal Continuum: When to Worry About the Continuous Electroencephalography Pattern

Cormier

Maciel

Gilmore

2017

Semin Respir Crit Care Med

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Continuous electroencephalography (cEEG) monitoring is an invaluable tool in the evaluation of encephalopathy and coma in critically ill patients. Marked increases in cEEG monitoring, coinciding with several societal guideline statements in the last decade, have allowed earlier detection and treatment of clearly harmful patterns, including nonconvulsive seizures (NCSz) and nonconvulsive status epilepticus (NCSE). However, it has also unmasked a range of EEG patterns of less clear clinical significance, with some more "malignant" than others given their potential association with increased neuronal stress and secondary brain injury. These patterns lay on a spectrum often referred to as the ictal-interictal continuum (IIC). To date, no definitive guidelines exist for the management of these potentially harmful EEG patterns, thus presenting a clinical dilemma for critical care physicians. Here, we review the various IIC patterns, their associated features, seizure risk, and outcomes and also propose a clinical approach to management based on the available data and expert opinion.

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“Ictal” lateralized periodic discharges

Cited by 27 publications

References 20 publications

Population of the ictal-interictal zone: The significance of periodic and rhythmic activity

Population of the ictal-interictal zone: The significance of periodic and rhythmic activity

Periodic lateralized epileptiform discharges can survive anesthesia and result in asymmetric drug-induced burst suppression

Ictal-Interictal Continuum: When to Worry About the Continuous Electroencephalography Pattern

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